[Chronic hydarthrosis of the knee in a Tunisian patient: tabetic arthropathy]. / Epanchement articulaire récidivant du genou chez un tunisien.

Tabetic arthropathy (TA) is a type of neuropathic arthropathy that has become rare. The purpose of this report is to describe a case of tabetic arthropathy involving the knee. A 53-year-old man was hospitalized for painless right knee arthropathy. Clinical examination demonstrated hydarthrosis of the right knee, peripheral neuropathic syndrome of the lower limbs, and paralysis of the IXth and Xth cranial pairs. Plain radiography showed the presence of lytic lesions in the internal femoral condyle and tibial plateau. Syphilitic serology tests were positive in the blood and cerebrospinal fluid.

[Primary hydatid cyst of the psoas muscle: description of 9 cases in Tunisia and review of the literature]. / Kyste hydatique primitif du psoas: 9 cas tunisiens et revue de la littérature.

The psoas muscle is an uncommon location for hydatid cyst accounting for only 1 to 3% of cases. The purpose of this report is to describe the epidemiologic, clinical, paraclinical, and therapeutic features of primary hydatid cyst of the psoas muscle. A retrospective study conducted in Surgery Department A at the Rabta Hospital in Tunisia compiled a total of 9 cases of primary hydatid cyst of the psoas muscle treated between 1980 and 2006. There were 6 men and 3 women with a mean age of 42.8 years. Symptomatology was nonspecific with pain in 6 cases. Discovery was coincidental in two cases. Clinical examination detected a mass in the presents of an abdominal mass in 7 cases. Radiologic findings (ultrasound and/or CT scan) confirmed diagnosis in 8 cases. In one case a mistaken diagnosis of psoas muscle abscess was made in a patient with an infected hydatid cyst. Serological tests were performed in 4 cases and were positive in 3. All patients underwent surgical treatment. The extraperitoneal approach (Leriche) was used in 7 cases and the transperitoneal approach via median laparotomy in 2. In all cases the surgical procedure consisted of partial cystectomy leaving a part of the pericystic against neurovascular structures. There was no operative mortality. The only postoperative complication was urinary infection in one patient. Mean follow-up was 2.5 years. One local recurrence was observed 4 years after surgical treatment and required reoperation.

[Radiologic diagnosis of enterosalpingeal fistula complicating Crohn's disease]. / Diagnostic radiologique d'une fistule entérotubaire compliquant une maladie de Crohn.

Enterosalpingeal fistula is a rare complication of Crohn's disease which is rarely diagnosed preoperatively. We describe a new case of this complication suspected by CT scan and confirmed by hysterosalpingogram and contrast from the ileum. This case is about a 50-year-old woman suffering from ileal Crohn's disease diagnosed two years previously and actually complicated by stenosis and entero-salpingeal fistula. The treatment consisted on resection of the ileocaecal region with salpingectomy. Postoperative course was uneventful.

Kyste hydatique primitif du psoas : 9 cas tunisiens et revue de la litterature

Le muscle psoas est une localisation exceptionnelle du kyste hydatique ne representant que 1 a 3des cas. Le but de ce travail est d'etudier les caracteristiques epidemio- logiques; cliniques; paracliniques et therapeutiques de cette entite. Notre etude est retrospective consecutive portant sur 9 cas de kystes hydatiques primitifs du psoas colliges entre 1980 et 2006 dans le service de chirurgie A de l'Hopital La Rabta. Il s'agissait de 6 hommes et 3 femmes dont l'age moyen etait de 42;8 ans. La symptomatologie etait atypique dominee par les douleurs retrouvees dans 6 cas. La decouverte etait fortuite dans deux cas. L'examen physique retrouvait une masse du flanc dans 7 cas. Le diagnostic etait confirme par la radiologie (echographie et/ou tomodensitometrie) dans 8 cas. Dans 1 cas; le diagnostic d'abces du psoas etait pose a tort chez un patient porteur d'un kyste hydatique infecte. La serologie hydatique pratiquee dans 4 cas etait positive dans 3 cas. Tous les patients etaient operes. La voie d'abord etait extra peritoneale (Leriche) dans 7 cas et transperitoneale a travers une laparotomie mediane dans 2 cas. Le geste a consiste dans tous les cas en une kystectomie partielle laissant une calotte de perikyste contre les elements vasculo-nerveux. La mortalite etait nulle. Un seul patient s'est complique en postoperatoire d'une infection urinaire. Le suivi moyen etait de 2;5 ans. Au cours de la surveillance postoperatoire; une seule recidive locale etait diagnostiquee a 4 ans postoperatoire ayant necessite une nouvelle intervention

[Necrotizing fasciitis complicating transthoracic biopsy]. / Fasciite nécrosante compliquant une ponction-biopsie transthoracique.

INTRODUCTION: Necrotizing fasciitis is a rapidly progressive and often fatal infection of the soft-tissue fascia deep to the skin but superficial to the muscles. We report a case of necrotizing fasciitis of the anterior chest wall complicating a percutaneous needle biopsy. CASE: A 49-year-old diabetic patient, presented persistent excavated right pulmonary opacities. A percutaneous biopsy was obtained and complicated by a necrotizing fasciitis. The patient underwent surgery for total resection of the necrotic tissues followed by antibiotic treatment. Outcome was favorable after 30 days of antibiotic therapy. DISCUSSION: Necrotizing fasciitis is a life threatening complication of transthoracic percutaneous biopsy. Prognosis depends on rapid diagnosis and treatment.

Primary central nervous system malignant melanoma: report of 5 cases.

Primary melanocytic neoplasms of the central nervous system consist of a spectrum of lesions ranging from well-differentiated melanocytoma to its overtly malignant counterpart, melanoma. Clinicopathologic features of 5 cases of primary central nervous system malignant melanoma were studied to define histologic appearances, diagnostic criteria, and the clinical behavior of lesions along this spectrum. There were three women and two men (mean age was 35 years) with symptoms of increased intracranial pressure. Radiological findings showed a solitary intra parenchymal lesion with variable enhancement after gadolinium administration. All patients underwent surgical treatment. Histologic examination revealed primary melanoma.

[Subcutaneous hydatid cyst. Case report of an exceptional location]. / Kyste hydatique sous-cutané: à propos d'une localisation exceptionnelle.

Primary subcutaneous cyst hydatid disease is an exceptional entity. We report a new case involving a 70-year-old woman hospitalized for a subcutaneous mass in the hypogastric area with no local inflammatory signs. Radiological examination was consistent with a partially calcified subcutaneous cyst in the hypogastric area. Complete surgical resection of the mass was performed with uneventful postoperative recovery. Histopathological examination of the surgical specimen demonstrated multivesicular hydatid cyst.

Huge cystic lymphangioma of the adrenal gland. A case report and review of the literature.

Cystic lymphangioma of the adrenal gland is a rare and benign lesion, most often found incidentally during abdominal imaging studies, abdominal surgery or at autopsy. Preoperative diagnosis is difficult. Diagnosis is histological. We report a 22-year-old female presented with abdominal pain. Laboratory findings were normal. Radiological examination revealed a 35 cm left adrenal cyst. The cyst was resected and the diagnosis of cystic lymphangioma of the adrenal gland was histologically made. In presenting this case and reviewing the literature, we seek to make better known the epidemiologic, the clinicopathologic presentation and the prognosis of this rare entity.

[Thoracic involvement in Behçet's vasculitis]. / Angio-Behçet à localisation thoracique.

Thoracic involvement of Behcet's disease is unusual but serious. It is related to the well known vascular tropism of the disease. It may involve the superior vena cava, pulmonary arteries, aorta and subclavian vessels. Imaging is useful for diagnosis and assess the degree of thoracic involvement. CT scan and MRI are obviously more accurate than angiography. The spectrum of thoracic manifestations of the disease is presented based on a review of 22 cases.

Spontaneous false aneurysm of the gastroduodenal artery in a hemophilic patient ruptured into the duodenum: case report.

Pseudoaneurysms of the splanchnic arteries are rare causes of gastrointestinal bleeding. We report a case of a spontaneous gastroduodenal artery false aneurysm ruptured into the duodenum in a patient with hemophilia. The diagnosis was confirmed by spiral computed tomography and magnetic resonance angiography. The patient died from massive gastrointestinal bleeding.

[Subcutaneous rupture of hydatid cyst of liver: dealing with a rare observation]. / Kyste hydatique ou foie rompu dans la paroi abdominale: a propos d'une observation rare.

Hydatid cyst of liver is a parasitosis of endemic proportions in Tunisia. The purpose of this report is to describe a case involving subcutaneous rupture of a hydatid cyst of liver in a 41-year-old patient. Diagnosis was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Subcutaneous rupture remains an uncommon complication. This is only the second case reported in the literature up to now.

[Malignant paraganglioma with vertebral and skull metastasis]. / Paragangliome malin avec métastases vertébrales et de la voûte crânienne.

A paraganglioma is a rare tumor composed of chromaffin cells. Malignant paraganglioma is a very rare presentation diagnosed by local recurrence after total resection of the primary mass or findings of distant metastasis. We report a case of a 30-year-old man who had undergone a carotid body tumor resection 10 years before and who presented to us with recurrence of the tumor associated with lymph node, vertebra and skull metastasis. The diagnosis of malignant paraganglioma was based on loco-regional and distant metastasis.

[Lipoma of the skull base. A case report]. / Lipome de la base du crâne. A propose d'un cas.

OBJECTIVES: Intra osseous lipomas are rare benign tumours that occur most frequently within the metaphysis of long bones. Involvement of the skull base is exceptional. We report a case of a lipoma of the skull base discovered incidentally. METHODS: A 45 year-old female patient consulted for galactorrhea with Hyperprolactinemia. RESULTS: MRI showed, in addition to the microadenoma, a high signal intensity T1 and T2 and fat saturated expansive lesion of the body and the right greater wing of the sphenoid. CT-scan of the skull base showed that this lesion was a well circumscribed fat containing and trabeculated lytic lesion leading to the diagnosis of a lipoma of the sphenoid. CONCLUSIONS: Lipomas of the skull base are exceptional. They are well recognized on CT-scan and MRI and in typical cases biopsies are not necessary. No treatment is necessary for asymptomatic lesions.

[Primary hydatid cyst of adrenal gland. Report of two cases]. / Kyste hydatique primitif de la surrénale. A propos de deux cas.

Primary hydatid cyst of adrenal gland is still an exceptional localization. The adrenal gland is an uncommon site even in our country in which echinococcal disease is endemic. We report two cases of primary hydatid cyst of adrenal gland presented with isolated abdominal pain. The diagnosis was based on CT-scan, which showed a cystic mass of respectively the right and left adrenal gland with a calcified wall. The echinococcal immunologic test (Elisa) was positive in one case. The surgical treatment consisted on a total resection of the cyst, without rupture of the cystic wall and preserving the gland. The diagnosis was confirmed on the macroscopic examination of the resected pieces. In the first case the cyst was multilocular filled with daughter cysts and in the second case the cyst was unilocular filled with hydatid membrane and clear fluid. In the two cases, the postoperative course was uneventful. No recurrence had occurred respectively after 24 months and 36 months of follow up.

Leiomyoma of the nasal cavity. A case report.

Most of the sinonasal tumours are of epithelial origin. Smooth muscle tumours are extremely rare, they account for less than 2.5% of the mesenchymal neoplasms of the sinonasal tract and the nasopharynx. Fewer than 30 cases of primary leiomyogenic tumours have been reported in the sinonasal tract with almost an equal frequency of benign and malignant types. We report a case of a rare leiomyoma of the nasal cavity. The pathological and the clinical characteristics of this tumour are discussed.

[Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas. A case report]. / Le carcinome indifférencié avec cellules géantes de type ostéoclastique du pancréas. A propos d'une nouvelle observation.

Undifferentiated carcinoma with osteoclast-like giant cells is a rare pancreatic neoplasm, with a possible cystic pattern, includes an adenocarcinoma component and giant cell mimicking osteoclastic bone tumor. We report the case of a 72-year woman admitted for jaundice and epigastric pain. Abdominal ultrasound and computed tomography scan revealed a 6 x 5 cm cystic and solid tumor of the pancreatic head with both bile duct and pancreatic duct dilatation. A pancreaticoduodenectomy was performed and pathologic examination revealed an undifferentiated carcinoma with osteoclast-like giant cells of the pancreatic head. The patient was alive and disease-free with a 18-month follow-up.

[Lymphoepithelial cyst of the pancreas. A case report]. / Kyste lymphoépithélial inhabituel du pancréas. A propos d'un cas.

Lymphoepithelial cyst of the pancreas is a benign and rare pathology. Its histogenesis is still unknown. The diagnosis is difficult to establish before surgery. We report a new case of a 20-year-old woman admitted for abdominal pain and vomiting. Radiologic investigations described a multilocular cystic tumor of the tail of the pancreas. The patient underwent a left pancreatectomy with splenectomy. Histologic investigations revealed pancreatic cysts lined by squamous epithelium surrounded by dense lymphoid tissue. The diagnosis of lymphoepithelial cyst of the pancreas was done.

[Gastro-epiploic lymphangioma. A case report]. / Lymphangiome gastro-épiploïque. A propos d'un cas.

The authors report a case of a gastro-epiploic lymphangioma in a 29-year-old male patient presenting with epigastric cramps. Physical examination was normal. Ultrasound and abdominal CT-scan showed a cystic mass under the left lobe of the liver containing fine septations and extending to the lesser sac. At surgery, a large cystic mass was found, situated around the celiac trunk. It was adherent to the lesser curvature of the stomach and posterior surface of the antrum and extended to the lesser sac. Excision of the mass and antrectomy were performed. Histologic examination was consistent with a diagnosis of cystic lymphangioma.

[Aorticopulmonary paraganglioma. A case report]. / Paragangliome aortico-pulmonaire. A propos d'un cas.

Paraganglioma is a tumor which develops from the paraganglion system, generally in the adrenal medulla (90%). Thoracic localisations are exceptional and arise essentially for the aortic and subaortic bodies, leading, in this case, to an anterior and posterior localisation. We report a case of non-chromaffin non-secreting aorticopulmonary paraganglioma, discovered fortuitously in a 64-year-old man.