[First cases of squamous cell carcinoma associated with cosmetic use of bleaching compounds]. / Premiers cas de carcinomes épidermoïdes sur terrain de dépigmentation artificielle.

INTRODUCTION: We report two cases of squamous cell carcinoma (SCC) in two black women (phenotype VI) using bleaching compounds for cosmetic purposes over a period of 15 years. CASE REPORTS: Two women (aged 45 and 47 years) with a long history of cosmetic use of bleaching compounds consulted at a dermatology unit for skin tumours. A diagnosis of SCC was confirmed by histological examination of tumour biopsies. One patient was HIV-positive. Surgical treatment was performed in both cases: simple postoperative complications were seen in one patient but the other died at home following recurrence of carcinoma in the year following diagnosis. DISCUSSION: To our knowledge, theses two cases represent the first description of SCC occurring after prolonged cosmetic use of bleaching compounds. Carcinoma occurred in both cases in skin exposed to sun. In our patients, the mechanism of carcinogenesis may have involved melanin destruction, solar exposure and corticosteroid-induced immunosuppression. A direct carcinogenic effect of hydroquinone or other unidentified compounds is another possibility; the carcinogenicity of hydroquinone is well established in rodents. While these observations do not provide formal proof of any implication of depigmentation products in SCC, they emphasize the need for monitoring of dark-skinned women using skin lighteners.

[Bilateral gestational macromastia: case report]. / La gigantomastie gravidique bilatérale: à propos d'un cas.

PURPOSE: We report a case of bilateral gestationnal macromastia in order to discuss the pathogeny, the diagnosis and the treatment. METHODOLOGY: It was a case of a 33-year-old woman, admitted for a bilateral massive hypertrophy of the breast occurring on pregnancy and with progressive evolution. She had three pregnancies and one born-infant. Biological exams have shown a hyperprolactinemia. Pathological exam of the mammary biopsy had shown a benign hyperplasia. RESULTS: Medical treatment of our patient by bromocriptin was inefficient. She has had a bilateral mastectomy. She is waiting for mammary plastic surgery. CONCLUSION: Gravidic macromastia is a rare pathology whose etiology and treatment are much debated. Frequent recurrence after mammary reduction justify the mastectomy followed by prothesis.

Reticulohistiocytose multicentrique : a propos de deux observations

Introduction :La Reticulohistiocytose Multicentrique (RHM) est une affection peu decrite dans la litterature. Nous rapportons deux observations de RHM faites a Dakar; caracteristiques par l'agressivite des lesions et la presentation cutanee pure dans un cas.Observations : La premiere observation concernait une patiente agee de 34 ans admise pour des papulo nodules dissemines; une polyarthrite bilaterale asymetrique destructrice n'epargnant pas les inter-phalangiennes distales et un epanchement sero-hematique aux genoux. La deuxieme observation etait faite chez une patiente agee de 26 ans qui avait des papulo-nodules dissemines depuis 10 ans. L'examen histologique en faveur de la RHM dans les deux cas; montrait une infiltration intradermique d'histiocytes multinucleees sans plasmocytes ni polynucleaires ni cellules xanthomisees. La corticotherapie etait decevante dans la premiere observation. La surveillance etait indiquee dans le deuxieme cas. Conlusion : La RHM est une maladie rare chronique handicapante a localisation tegumentaire diffuse isolee exceptionnelle en Afrique

[Gynaecological and breast cancers at the Dakar Cancer Institute]. / Les cancers gynécologiques et mammaires à l'Institut du cancer de Dakar.

OBJECTIVE: To determine the frequency of gynaecological and breast cancers among women and to study their risk factors and diagnostic aspects at the Institut Curie of Dakar. PATIENTS AND METHOD: This retrospective study included all cancers seen at the Institute in 2001. Epidemiological and clinical variables were collected from the patients' medical records and analysed. RESULTS: This study showed that of all 786 cancers in women, 507 were gynaecological or breast cancers. Cancer of the uterine cervix accounted for 240 cases (47.3%), followed by 213 cancers of the breast (42%), 35 of the ovaries (6.9%), 10 of the corpus uteri (2%) and 7 of the vulva (1.4%). Mean age was 49.9 years old. There was a statistically significant (p<0.05) between primary tumour sites and all of the following: age at menarche, age at first sexual relations, and number of sexual partners. Mean time until consultation for all patients was 8.24 months and 96% had clinical signs before diagnosis. The histological confirmation rate was 73%. Local or regional tissue involvement was noted in 60% of cases. CONCLUSION: Gynaecological and breast cancers are frequent in Dakar and have the characteristics common to cancers in developing countries. Further efforts are needed to study their risk factors and effective screening for them.

[Vulval bilharziasis]. / Localisation vulvaire de la bilharziose.

Vulvar localisation of schistosomiasis is a rare presentation. We report a case of a woman of 20 years old hospitalised for a vulvar mass of six months. That mass progressively increased in volume and was tender. It was accompanied by frequency and dysuria. The patient had a history of swimming in fresh water and hematuria when she was eight years old. Initial clinical examination found a good general state, there was a mass involving the clitoris and the small lips. This painless mass had a cauliflower appearance and was soft with a large implantation. Pathology exam of the mass revealed a vulvar schistosomiasis with an important amount of living eggs. A tumour removal with a plasty of small lips was performed. Additionally, praziquantel was administered orally. Vulvar localisation of schistosomiasis might suggest a malignant tumour. Only pathological examination can assess the diagnosis.

Dynamics of anti-VAR2CSA immunoglobulin G response in a cohort of senegalese pregnant women.

BACKGROUND: Pregnancy-associated malaria (PAM) is precipitated by the accumulation of parasites in the placental intervillous spaces and causes maternal anemia and low birth weight. In PAM, placental parasites adhere to chondroitin sulfate A (CSA) through a unique set of variant surface antigens (VSAPAM). Several studies have shown that 1 var gene, var2csa, is transcribed at high levels and expressed in CSA-binding Plasmodium falciparum parasites. METHODS: Plasma levels of anti-VAR2CSA immunoglobulin G (IgG) in Senegalese women were measured during pregnancy by enzyme-linked immunosorbent assay, using 3 recombinant proteins representing 3 domains of the var2csa gene product. RESULTS: The 3 recombinant proteins were specifically recognized by plasma from pregnant women but not by control plasma. A parity-dependent recognition pattern was observed with 2 of the 3 VAR2CSA antigens. A kinetic study demonstrated that a single P. falciparum infection was able to trigger a VAR2CSA-specific antibody response. Among women with infected placentas, women with high anti-VAR2CSA IgG levels at enrollment were more likely to present with a past infection than with an acute/chronic infection. CONCLUSIONS: Anti-VAR2CSA IgGs are involved in clinical protection against pregnancy-associated malaria and strengthens the hope for making a VAR2CSA-based vaccine.

[Giant compressive mediastinal lipoma: a case report]. / Lipome géant compressif du médiastin: a propos d'un cas.

Mediastinal lipoma is a rare mesenchymatous fatty tumor in child. Usually asymptomatic, it can cause asphyxiation. The authors report the case of an 18 month-baby-girl referred to us by the pediatric department for asphyxiation. The chest X ray was evocative of a mediastinal tumor. A sudden cardiorespiratory failure leads us to perform thoracotomy. A fatty tumor was found compressing the heart and the left lung. It was easily extirpated. The postoperative recovery was uneventful. Light microscopy showed a lipoma. This compressive form shows the severity of the mediastinal lipoma when it reaches a large size. The literature on this rare pathology is reviewed.

[Histoepidemiologic profile of 375 primary bowel cancers at the University Hospital Center in Brazzaville, Congo]. / Profil histo-epidemiologique de 375 cancers digestifs primitifs au CHU de Brazzaville.

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville, Congo from January 1992 to December 2001. Incidence was 14.6%. The sex ratio was 1:5. Age ranged from 39 to 49 years. The liver (40.2%) was the most frequent location followed by the colon/rectum (30.2%), stomach (26.2%), and esophagus 2.1%. Predisposing factors included low-fiber diet, heavy consumption of smoked foods, and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57% of cases was adenocarcinoma that was observed in the esophagus, stomach, colon, rectum, and pancreas. Systematic screening and treatment of precancerous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer.

[Non-Hodgkin's lymphoma in Dakar: study of 107 cases diagnosed between 1986 and 1998]. / Les lymphomes non hodgkiniens à Dakar: étude réalisée sur 107 cas diagnostiqués entre 1986 et 1998.

Non-Hodgkin's Lymphomas (NHL) are the most prevalent malignant hemopathies in Senegal. In this study we have investigated the epidemiological aspects considering the HIV infection pandemic, and evaluated the diagnosis means and evolutive features of this disease in Dakar. Between 1986 and 1998 (13 years), we collected 107 cases of NHL, all histologically confirmed. Average age of patients was 31.4 years (2-85 years) and sex ratio was 21. HIV infection was found in three out of 62 patients tested (4.8%). At moment of diagnosis, 72% of patients were in stage III or IV according to the Ann Arbor Staging System. Large cell lymphomas were predominant (67.2%), followed by small lymphocyte lymphomas (24.2%) and follicular lymphoma with 8.4% of cases. Localization of lymphomas was exclusively nodal (30.8%) or extra nodal (31.7%) or mixed (37.3%). In therapeutical field, 21.5% of patients were treated with only symptomatical means. Chemotherapy was used in 54 patients (78.2% of treated patients), surgery was performed in 6 patients (8.6%), association of radiotherapy and chemotherapy in 5 patients (7.2%) and 4 patients (5.7%) were treated with surgery + chemotherapy. The average survival time was 344 days. Four patients (3.7%) were alive 3 years after diagnosis and only 2 patients (1.8%) after 5 years.

[Primary lymphoma of the thyroid: a case report]. / Lymphome primitif de la thyroïde: a propos d'un cas.

Primary lymphoma of the thyroid is an uncommon disease. It diagnosis is difficult without immunohistochemestry. We report a case of thyroid lymphoma diagnosed at the A. Le Dantec Hospital of Dakar. A 22-year old young man presented anterior neck mass. Clinical examination showed a thyroid mass with a susclavicular palpable lymph node. The scintigraphy demonstrated that the mass was cold. Total thyroidectomy with cervical lymphadenectomy was the first treatment. Histological examination of the surgical specimen concluded that the mass was an anaplastic lymphoma (large cells type) involving the sus clavicular lymph nodes (stage IIE). Chemotherapy was administrated after one month with C-MOPP schedule. The patient presented no recurrent sign after 30 month. Fine needle aspiration and immunocytochemestry of the thyroid cold masses will contribute in an accurate diagnosis and the management of disease in our institution.

[Portal and splenic veins thrombosis reveling a miliary tuberculosis of the liver]. / Une thrombose portale et splénique révelant une tuberculose miliaire du foie.

The etiologies of the portal vein trombosis are dominated by the neoplasic forms with hepatocellular carcinoma; we report a rare case of portal and splenic veins thrombosis revealing a liver military tuberculosis occuring in a HIV 1 infected patient. A 42 years old senegalese woman with no personal or family history of thrombosis was admitted for abdominal upper right quadran, and epigastric pain, with fever and important weight loss. Ultrasound identified endoluminal echogenic images in the portal and splenic veins. There were no lymph nodes or liver tumor. Evaluations of proteins C and S were normal and there was no anticardiolipin antibody. In searching the aetiology of the thrombosis, a liver biopsy was performed, and showed a miliary tuberculosis. an HIV 1 infection was later on diagnosed. The antituberculosis treatment associated with heparine therapy was successful, the thrombosis resolved entirely. This portal and splenic veins thromboses occuring on a miliary tuberculosis of the liver seems to be an exceptional situation. We did not found in the literature a similar case.lt points out the interset of liver biopsy in searching the aetiology and the early heparine therapy set up

Cancer du sein chez l'homme africain : 46 observations dakaroises

Il s'agit d'une etude retrospective de 46 cas de cancers du sein survenus chez l'homme et colliges a l'institut du Cancer de Dakar de 1957 a 1999. L'age moyen des malades etait de 60;7 ans et la duree moyenne des symptomes etait de 37;5 mois. La repartition des malades selon la classification TNM de l' UICC revelait : 1T1; 1T2; 4T3; 40T4; 40N1; 1N2; SN3; 10M1 PUL; 8M1 OSS et 2M1 HEP. Le carcinome canalaire invasif representait 78;2 pour cent de l'ensemble des lesions histologiques. Nous avons realise 32 mastectomies dont 23 etaient associees a un curage axillaire. La chirurgie etait associe a une chimiotherapie dans 25 cas et a une radiotherapie dans 14 cas. Le traitement hormonal au Tamoxifene fut institue dans 7 cas. Le suivi moyen des malades etait de 24 mois. Le pronostic de ces cancers pourrait etre ameliore par une meilleure education et un diagnostic plus precoce

Profil histo-epidemiologique de 375 cancers digestifs primitifs au CHU de Brazzaville

This retrospective study was undertaken to determine the histoepidemiologic profile of primary digestive tract cancer based on analysis of 375 of the 2558 cases diagnosed in the Cytopathology Department of the the University Hospital Center in Brazzaville; Congo from January 1992 to December 2001. Incidence was 14.6. The sex ratio was 1:5. Age ranged from 39 to 49 ye a rs. The liver (40.2) was the most frequent location followed by the colon/rectum (30.2); s t o m a ch (26.2); and esophagus 2.1. Predisposing factors included low-fiber diet; heavy consumption of smoked foods; and history of hepatitis B and C virus infection. The most frequent histological entity accounting for 57of cases was adenocarcinoma that was observed in the esophag u s ; stomach; colon; rectum; and pancreas. Systematic screening and tre atment of pre c a n c e rous lesions in high-risk patients is necessary to reduce the incidence of digestive tract cancer

[Giant pleomorphic adenoma of the submaxillary gland: case report]. / Adénome pléomorphe géant de la glande sous-maxillaire: à propos d'une observation.

We report an exceptional case of giant cell tumor of the submaxillary gland in a 76-year-old woman. The tumor progressed slowly over a period of 40 years. Submaxillectomy removed a 3-kg mass before fixation. The postoperative period was uneventful and the patient was discharged fifteen days later. Pathology examination revealed a pleomorphous adenoma developed within the salivary gland.

Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal.

BACKGROUND: The cosmetic use of bleaching products is considered a common practice in dark-skinned women from sub-Saharan Africa. However, there are few studies on this subject. OBJECTIVES: To increase the knowledge about the dermatological consequences of this practice in Dakar, the capital of Senegal. METHODS: A representative sample of 368 adult women presenting at our dermatological centre was selected. Each woman was questioned about her cosmetic use of bleaching products. Next, the following data were recorded in 425 women who used bleaching products: names and types of products used; modalities of the skin bleaching practice; skin diseases motivating the dermatological visit, with recording of their clinical features; and results of a full skin examination. The active substances of the bleaching products were determined mainly by reading the indications on their packages; with products of unknown composition, a pharmacological analysis of samples was done. A statistical analysis was performed. RESULTS: Of the 368 women questioned, 194 (52.7%) were current users of bleaching products. Concerning the 425 users enrolled, products were applied on the whole body in 92% of users, with a median duration of use of 4 years. The active principles used included hydroquinone (used by 89% of users), glucocorticoids (70%), mercury iodide (10%) and caustic agents (17%); 13% of users used products of unknown composition. In the samples that were analysed, hydroquinone was found at concentrations of between 4% and 8.7%. Concerning steroids, superpotent (class 1) glucocorticoids predominated. The main skin complaints in bleaching products users included dermatophyte infections (n = 105) and scabies (n = 69), both often unusually extensive and severe; acne (n = 42), often severe; eczema (n = 41); irritant dermatitis (n = 14); and dyschromia (n = 26, including 14 cases of exogenous ochronosis). The skin examination noted features apparently disregarded by users: striae (noticed in 39% of users), and macular hyperchromia involving the face, mainly the periocular area (33%). The statistical analysis showed that glucocorticoid use was associated with the presence and severity of infectious skin diseases, and of acne. CONCLUSIONS: More than half of the adult women presenting at our dermatology centre were using bleaching products. Most skin diseases observed in bleaching products users appeared to be induced, aggravated or modified by this practice. Superpotent topical glucocorticoids appeared to be the main agents responsible for the observed complications. The cosmetic use of bleaching products therefore has a major impact on our current dermatological practice.

[Uterine leiomyoma at the surgical department of the Teaching Hospital of Dakar. Report of 140 cases operated in two years]. / Les fibromes utérins à la clinique chirurgicale du CHU de Dakar: à propos de 140 cas opérés en deux ans.

Uterine leiomyomas due to complications in particular mechanical and haemorrhagic constitute a frequent motive of consultation to the surgical department at the university hospital of Dakar. To precise its epidemiologic, clinical and therapeutic aspects, a prospective study of two years (1995-1996) was made. Hundred and forty patients operated for uterine leiomyoma in our department were brought together. Uterine leiomyoma represent 58.82% of the gynaecological disorders operated to the surgical department. These gynaecological affection constitute 15% of the whole surgical pathology. The edge of age most concern was the decade 49-59 years old. The infertility and the low parity were found in 55.14% of the cases. The average delay of consultation was 39 months. The clinical symptoms amounted it metrorrhagia (72%) abdominal or pelvic pains (77.1%) and increase of the volume of the belly (96.4%). The overall reoperating rate was 3.5%. The pelvic ultrasonography allowed to confirm the diagnosis in 84.28% of the cases. The under umbilical laparotomy (90.9%) was the main surgical way. The sub-total hysterectomy was carried out in 35.72% of the cases. The average duration of hospitalization was 9 days and the mortality 0.7%. Main postoperative complications were parietal abscess (16 cases), evisceration (2 cases) and eventration (2 cases). Histological examination realized in 48.06% of the cases confirmed the diagnosis of uterine leiomyoma in every case. In 17.82% of the cases leiomyoma were associated to another lesion and in two cases it was a neoplasm of the uterine cervix. Uterine leiomyomas are frequent in Dakar. Their often impressive volume and metrorrhagia dominant their occasion of diagnosis. Their sufficiently early diagnosis have to noticeably reduce their radical surgery indications in this benign pathology whose association with cervix uterine cancer stays very rare in our daily practical experience.

[Pheochromocytoma in Dakar: report of nine cases]. / Le phéochromocytome à Dakar: à propos de neuf observations.

Pheochromocytoma is a catecholamine-secreting neoplasm of chromaffin tissue. The most common symptom is hypertension but there are incidentally discovered forms at imaging. From 1981 to 1998, the authors observed nine pheochromocytomas through three hospitals in Dakar. This study included seven male and two female patients. The average age was 31.61 years. Hypertension was present in 77% of the cases. Headache, palpitations and sweating were the authors most frequent symptoms, occuring in 55% of cases. Measurement of vanillyl mandelic acid level in six cases and urinary metanephrines in three cases made the diagnosis. There were six adrenal and three extra adrenal pheochromocytomas with two malignant tumors features. In our countries, measurement of urinary metanephrines and computed tomography processing may improve detection of pheochromocytomas.

[Ultrasound-guided puncture and biopsy in the diagnosis of chronic liver diseases: report of 447 cases]. / Ponctions cytologiques et biopsiques dans le diagnostic des hépatopathies chroniques: à propos de 447 cas.

Our aim was to evaluate practices of percutaneous liver biopsies over the last 11 years in our center in focal or diffuse liver disease. Records of 447 patients who underwent ultrasound-guided liver biopsy between 1998 and 1999 were reviewed. Three experienced physicians performed all liver biopsies with a Menghini needle or fine needle. In all cases the puncture site was determined using prebiopsy ultrasound. Liver biopsies were performed on 423 hospitalized patients and 24 outpatients. The suspicion of primary liver cancer was the indication in 72.7% of the cases. In 75.2% patients definitive or indicative pathological diagnosis were obtained. 208 biopsies out of 229 (90.8%) and 215 cytological punctures out of 239 (89.9%) were interpretable. Histological diagnosis obtained were primary malignamt tumor in 235 cases (58.2%), cirrhosis in 26 cases (6.4%), chronic hepatitis in 32 cases (7.9%), and normal tissue in 56 cases (13.9%). Only 2 hemorrhagic complications requiring blood transfusion (0.4%) and one needle-tract tumor seeding (0.2%) occured 42 months later. We concluded that ultrasound-guided percutaneous liver biopsy is a quick method of assessment increasing the diagnosis yield by this procedure and maintaining low complications.

[Complicated parathyroïd adenoma. A case report]. / Adénome parathyroïdien compliqué: a propos d'une observation.

Parathyroid adenoma is the first etiology of primary hyperparathyroidism althrough the majority of patients with primary hyperparathyroidism have a relatively asymptomatic benign disorder. There are patients who have a more aggressive disorder. We report a case of 41 years old man whose primary hyperparathyroidism was discovered through exploration of recurrent ureteral stone associated with severe hypertension. The diagnosis was set up on high level serum calcium and low serum phosphorus with very elevated level of parathyroid hormone. Adenome was localised by ultrasound examination. The patient underwent successfully surgery and the pathological study confirm the diagnosis. This case illustrate the importance of investing earlier ureteral recurrent stone to prevent severe complications of primary hyperparathyroidism.