Lichen planus pemphigoides: four new cases and a review of the literature.

Lichen planus pemphigoides (LPP) is a rare autoimmune blistering disease. It appears to be combination of lichen planus and bullous pemphigoid. We describe four new cases of LPP and discuss the epidemiological, clinical, pathological, and therapeutic features of this singular association through a review of the 74 published cases within the English literature. We report four cases of LPP (three women aged respectively 47, 51, and 53 years old, and a 53-year-old man). All patients presented with bullae on lichenoid and normal skin, predominately on the extremities. The diagnosis was confirmed by immunohistological findings. Our patients were treated with oral corticosteroids with a good response. Our review of the literature of 78 cases of LPP (65 adults and 13 children) showed that it involved adults (mean age: 54 years), with a slight female preponderance. A mean lag time between LP and the development of LPP was 8.3 months. LPP is characterized by developing blisters on lichenoid lesions and on uninvolved skin with more acral distribution of bullous lesions. Involvement of palms and soles was more frequent in children. The diagnosis is based on pathological and immunological confrontation. LPP is usually idiopathic, but some cases were reported in association with various drugs. There have also been reports of association with internal malignancy. Most cases of LPP are successfully treated with systemic corticosteroids. In most cases, the prognosis was good.

Childhood erythema nodosum associated with kerion celsi: a case report and review of literature.

Erythema nodosum (EN) in association with kerion celsi is a rare condition in children, with only 11 cases having been reported in the English literature. We describe a new case in a 7-year-old boy in whom the disorder had begun 2 months before. He had many inflamed, boggy, suppurative nodules over the left occipitoparietal area of the scalp and, 2 weeks later, developed multiple painful, erythematous subcutaneous nodules of the shins, thighs, and upper limbs. EN was confirmed by histologic examination. Our review of the literature of all cases of EN during kerion showed that it usually occurs at or slightly after the height of infection or after drug introduction. Trichophyton mentagrophytes was involved in the majority of cases, and improvement of EN usually occurs with griseofulvin.

Simvastatin-induced dermatomyositis in a 50-year-old man.

Dermatomyositis (DM) is a rare inflammatory autoimmune disease for which an iatrogenic origin has been described in a few cases. The authors report a case of DM occurring after simvastatin intake. A 50-year-old male sought medical attention for a photodistributed rash and considerable muscular weakness present for 3 months. One year earlier, simvastatin had been introduced. Serum creatine kinase levels were elevated. Histological examination of a muscle biopsy was consistent with a diagnosis of DM. Investigation for neoplasia and associated autoimmune disease proved negative. All clinical and laboratory abnormalities diminished corticosteroid therapy (1 mg/kg/day). Case reports have suggested that lipid-lowering drugs, especially statins, could induce or reveal chronic muscle diseases. In statins myopathy, reduction of coenzyme Q has been discussed as a key mechanism. Our case of DM in a patient receiving simvastatin adds to the previous reported cases in the literature and highlights the potential role of statins as triggers of immune systemic diseases.

A Primary Testicular Diffuse Large B-cell Lymphoma Belonging to the Germinal Center B-cell-like Group.

UNLABELLED: Testicular lymphoma was first reported by Malassez and Curling in 1866. Primary testicular lymphoma constitutes only 1 - 7% of all testicular neoplasms and less than 1% of all non Hodgkin lymphoma. The authors report a new case of primary testicular lymphoma and highlight its diagnostic and therapeutic challenge. We report the case of a 26-year old man without a particular past medical history, who presented with a painful right testicular swelling that he has noticed for several weeks. Radiological findings consisted in multiple hypoechoic masses that corresponded in histological examination to a diffuse intratubular lymphomatous infiltration situated away from the spermatic cord, the epididymis, ductuli efferentes and rete testis. Immunohistochemical study showed positivity for leukocytic common antigen (CD45), B-cell marker (CD20) and bcl 6. The patient underwent full staging for lymphoma showing no evidence of extra-testicular involvement by lymphoma and no lymph nodes. The diagnosis of stage I primary testicular large B-cell lymphoma of germinal center B-cell-like group was made. The patient is now treated by chemotherapy. Primary testicular lymphoma is a rare tumour whose diagnosis is based on histological findings. There are non consensual etiological or predisposing factors. Treatment modalities consist in surgical excision, chemotherapy and radiation therapy but the accurate procedures are not standardized. Factors that have been linked to more favorable outcomes include younger patient age, localized disease, presence of sclerosis at pathologic analysis, smaller tumour size, lower histological tumor grade and lack of epididymal or spermatic cord involvement. KEYWORDS: Testicular lymphoma; Germinal center; B-cell.

[Paraganglioma of urinary bladder: report of two cases]. / Le paragangliome vesical: a propos de deux observations.

BACKGROUND: Extra-adrenal pheochromocytoma is a rare entity. Its occurrence in the urinary bladder has only been reported less than 200 times. AIM: Report 2 news cases CASES REPORT: Here we present two case reports of bladder paraganlioma with an update of the diagnostic techniques, treatment modalities and follow-up of patients with this disease. The common presentation of paraganglioma of the urinary bladder is painless haematuria, headache, palpitation and anxiety. Treatment of this lesion requires the same preparation as for any other site of pheochromocytoma. Partial cystectomy ensures radical and effective treatment. Long-term surveillance is necessary as recurrences or metastases have been described 20 and 40 years after treatment.

Lymphoepithelioma-like carcinoma of the skin in a tunisian patient.

Lymphoepithelioma-like carcinoma of the skin (LELCs) is a rare cutaneous neoplasm with histologic features resembling lymphoepitheliomatous tumors of the nasopharynx. The association of lymphoepitheliomas with Epstein-Barr Virus (EBV) at some extracutaneous sites is well documented. In contrast, the presence of EBV in LELCs has never been shown in either Caucasians or Asian patients. We present the first case of LELCs in a Tunisian patient, a 78-year-old woman who presented with a nodule of the right cheek of 2 months' duration. The patient underwent surgical excision and there was no evidence of local recurrence 6 months later. Histologically, the entire dermis was occupied by lobules composed of atypical epithelial cells surrounded by a dense lymphoplasmacytic infiltrate. Immunohistochemical examination showed that the epithelial tumor cells were positive for cytokeratin and epithelial membrane antigen. In situ hybridization investigations for the presence of EBV-encoded RNA showed negative results. Our findings suggest that LELCs is not related to EBV among North African patients.

[Warty dyskeratoma or "follicular dykeratoma": a clinicopathologic features of a new entity]. / Dyskeratome verruqueux ou "dyskeratome folliculaire": aspects anatomo-cliniques d'une nouvelle entité.

INTRODUCTION: Warty dyskeratoma is a rare, benign, epithelial tumor characterized by a variable clinicopathologic spectrum. In all cases, lesions revealed foci of acantholytic dyskeratosis. CASE REPORT: A 74-year-old man has for two year developped a single small nodule with a hyperkeratotic area on the scalp. Histopathology revelead a warty dyskeratoma. DISCUSSION: Warty dyskeratoma is an epithelial tumor. Histopathology is important for the diagnosis. On the basis of our findings and from the literature, we propose to discuss the nosologic problem of this entity.

[Doctor Mahmoud el Materi one of the first physicians and militants of Tunisia]. / Le Docteur Mahmoud el Materi médecin et militant de la première heure.

Mahmoud el Materi was undoubtedly, one of the main leading figures of contemporary tunisian history. Open and brillant, he detained a vast knowledge, but was nevertheless a man of moderation and humility, and a humanist who dedicated his entire professional and militating life to the service of the people of Tunisia. In a country, stricken then by poverty and widespread human misery, he was a remarkable militant who fought for independence and greatly contributed to the rebirth of modern Tunisia.

[Multiple lymphomatous polyposis of the gastrointestinal tract: a Tunisian case]. / Polypose lymphomateuse multiple du tube digestif: un cas Tunisien.

Multiple lymphomatous polyposis is a distinctive primary gastrointestinal lymphoma which endoscopical, histopathological et immunophenotypical characteristics are well known. This lymphoma is rare and its prognosis is bad because of frequency of stage IV patients. We report the case of a 75-year-old male patient with multiple lymphomatous polyposis affecting the rectum, the colon and the stomach associated with an involvement of lymphadenopathies, bone marrow and liver. Treatment by chemotherapy was ineffective and patient dead after 3 sessions of CEOP protocol.