[Renal actinomycosis: a case report]. / Actinomycose rénale: a propos d'une observation.

This report describes the case of a 26-year-old patient hospitalized for spontaneous abdominal pain. Palpation during clinical examination demonstrated a mass in the right abdomino-pelvic cavity. Radiological examination visualized the presence of grains suggestive of actinmycosis. The patient responded favorably to antimicrobial therapy. Actinomyces israeli is a gram-positive anaerobic bacterium that can cause tumor-like lesions usually on the face and neck and more rarely on retroperitoneal structures. Because renal involvement can require nephrectomy, diagnosis of renal actinmycosis must be made during pre-operative work-up. Ultrasound-guided needle biopsy of the lesion can achieve diagnosis and avoid nephrectomy since medical treatment using antimicrobial therapy is effective.

[Unusual presentation of visceral leishmaniasis in an immunocompetent patient]. / Mode de révélation inhabituel d'une leishmaniose viscérale chez un sujet immunocompetent.

Visceral leishmaniasis due to Leishmania infantum is endemic in Tunisia. The incidence in adult patients has increased in recent years; but most of these patients are not HIV positive as in other Mediterranean countries where all the cases are associated with HIV. We present the case of a woman with symptoms suggestive of leishmaniasis but whose bone marrow was sterile and whose serological tests for Leishmania spp. were negative. For this patient, the parasite was only detected in a routine duodenal biopsy. There are few reports of visceral leishmaniasis cases diagnosed by duodenal biopsy and almost all patients were HIV positive in that case. Thus it seems interesting to perform a duodenal biopsy in case of a difficult diagnostic even in the absence of gastrointestinal symptoms and/or HIV infection.

Malignant granular cell tumor of the abdominal wall.

The granular cell tumor is an uncommon tumor that usually appears as a solitary small nodular growth and runs a benign course. It occurs widely throughout the body, but is rarely described in the abdominal wall. The authors report a case of malignant granular cell tumor which was arising in anterior abdominal wall of a 67-year-old woman. Malignant variant is rare and the abdominal wall site is extremely uncommon. Regarding this clinical case and the literature the authors purpose to review the criteria of malignancy.

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.

Colonic adenocarcinoma and bilateral malignant ovarian sex cord tumor with annular tubules in Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome is characterized by multiple polyps throughout the gastrointestinal tract in association with mucocutaneous pigmentation. Although Peutz-Jeghers syndrome polyps are hamartomas, frequent association of this syndrome with both gastrointestinal and non-gastrointestinal tumours had led to reassessment of the cancer risk in this hereditary disorder. The most common gynaecological tumors in this syndrome are adenoma malignum of the uterine cervix and ovarian sex cord tumor, particularly sex cord tumor with annular tubules. The question of malignant change in a polyp or of the association of gastro intestinal carcinomas still discuss. The authors report a case of Peutz-Jeghers syndrome in a young patient who developed a colonic adenocarcinoma in a hamartomatous polyp together with an incidentally discovered bilateral malignant sex cord tumours. We discuss its association with certain benign and malignant tumors and the risk of rare complications of these hamartomatous polyps. Although malignant tumors are increasingly reported in association with the Peutz-Jeghers syndrome, to our knowledge, there have been no previous reports of such an association in the literature.

[Pyoderma gangrenosum. 15 cases]. / Pyoderma gangrenosum. A propos de 15 observations.

We report a retrospective study of 15 cases of pyoderma gangrenosum. The male/female ratio was 2, average age 40 years (range: 2-48 years). The typical ulcerous form was observed in 11 patients, whereas bullous pyodrma gangrenosum was noted in 2 patients and the granulomatous superficial form in 2 others. The leg was the most frequent localization. It was often associated with another skin localization. Two patients had neutrophilic pulmonary involvement which was concomitant to the skin ulcers. Association with internal disease was found in 8 patients. Histology showed vasculitis in 11 patients. In 9 of them, leukocytoclastic vasculitis was observed. Prednisone and clofazimine were the most frequently prescribed drugs. Th rate of recurrence of pyoderma gangrenosum was 46% independently of treatment. Occurrence of neutrophilic pneumopathy was rapidly fatal in two of our patients

[Intestinal metaplasia at the gastroesophageal junction - epidemiologic and histologic aspects. Report of 164 cases]. / Metaplasie intestinale de la jonction oeso-gastrique aspects epidemiologiques et histologiques. A propos de 164 cas.

Adenocarcinoma of the gastric cardia is increasing in incidence. The purpose of this study was to determine whether intestinal metaplasia of the esophagogastric and having a malignant potential junction can be considered as an ultra-short segment Barrett's esophagus. To study the epidemiologic and histological features of the intestinal metaplasia of esophagogastric junction two groups of patients were compared for the prevalence of this condition. Group 1 included 82 patients with gastroesophageal reflux symptoms et group 2 consisted of 82 healthy individuals. Both groups had two biopsy specimens taken from the esophagogastric junction. Histological evidence of intestinal metaplasia was defined as specialized columnar epithelium containing goblet cells staining with alcian blue at pH 2.5. Intestinal metaplasia of the esophagogastric junction was present in 12 patients in group 1 and 9 individuals in group 2. The global prevalence of this condition was 12.8% and there was not a statistically significant difference in the prevalence of this condition between the two groups. A significant difference could not be found when sex was considered. There was a significant association between this condition and older age (p = 0.01). Intestinal metaplasia of the esophagogastric junction and Barrett's esophagus do not have the same epidemiologic features. Therefore, we suggest that screening biopsy specimens of the esophagogastric junction be limited to study protocols at this time.

Gastric MALT lymphoma. A clinico-pathological study of 65 cases. Relationship to Helicobacter pylori.

We report 65 cases of MALT gastric lymphomas. HP was looked for with Giemsa and Whartin Starry stains. Immunohistochemistry was done with PAP method. Anti-HP treatment was used in 9 cases. 38 were of low grade of malignancy, 23 were high grade, 4 were high grade with a low grade component. The mean age was 51.5 years, the sex ratio 1.5. Epigastric pain was the most frequent feature (87.7% of cases). Endoscopically, low grade lymphomas presented as unique or multiple ulcerations (55.3% of cases) with antral localisation (52.6% of cases). 60% of our patients were stage IE, of which 61% had low grade lymphoma, 18% were at stage II2E, 10% at stage III and 10% at stage IV. From 23 operated patients, 29% had early lymphoma which was low grade malignant in 71.5% of cases, and 71% had lymphomas which were widely spread beyond the submucosa. HP was found in 63% of cases. Histologic regression of two early lymphomas of low grade malignancy was achieved after HP eradication.

[Paraganglioma of the cauda equina. Apropos of a case with review of the literature]. / Paragangliome de la queue de cheval. A propos d'une observation avec revue de la littérature.

Paragangliomas are unusual neuroendocrine tumors. The most common anatomical site is within head and neck (90%). It has rarely been described in the region of the cauda equina. We report the case of a 49 years-old white woman who presented with a slow, progressive cauda equina syndrome over a 20-years period. Radiological examination showed erosion of the vertebral laminae of L4, L5 and S1 and disclosed an intra-dural mass lesion occupying the entire spinal canal between L4 and S1. The patient underwent sub-total excision and adjuvant radiation therapy. Histological examination concluded to a paraganglioma. This diagnosis was confirmed by immunohistochemical studies.

[Synovial lipoma arborescens]. / Lipomes arborescents de la synoviale.

The synovial lipoma are uncommon articular tumors of unknown origin. We report two cases of synovial lipoma arborescens arisen in a man and a woman respectively 41 and 27 years old. Both had already consulted for a tumefaction progressively increasing in volume. It was accompanied in the first case by a laxity in the knee joint. Radiography and arthroscopy showed an important hyperplasia of the articular synovia. A total synovectomy was performed in both cases. The synovia had a hairy aspect and was extremely thickened. It weighted 1.5 kg in the first case and its section had a fatty aspect. The histological examination confirmed the diagnosis of synovial lipoma arborescens. The observed aspect of the two tumors and particularly their volume, which was very important in the first case are arguments in favor of their tumoral nature.

[Fibrous inflammatory polyp of the digestive tract. Apropos of 5 cases]. / Le polype fibro-inflammatoire du tube digestif. A propos de cinq observations.

Inflammatory fibroid polyp is a rare benign tumor of the digestive tract. The authors report three cases: two intestinal and one gastric. These cases are of particular interest because of the association ill one case of an intestinal submucosal lipoma with the inflammatory fibroid polyp, and the existence in the gastric case of an inflammatory reaction caused by food debris. This offers, further evidence in support of the theory implicating a chronic inflammatory reaction.