Aspects histo-epidemiologiques des cancers solides du rein de l'enfant en Cote d'Ivoire

Objectifs: A partir d'une etude retrospective transversale; les auteurs rapportent 34 cas de cancer du rein histologiquement confirmes chez l'enfant de moins de 16 ans; observes dans les services d'Anatomie Pathologique des centres hospitaliers et universitaires d'Abidjan (Republique de Cote d'Ivoire) au cours de la periode allant de janvier 1984 a decembre 2007e. Patients et methodes: Le materiel d'etude etait constitue de piece de nephrectomie. Apres fixation dans le formol a 10; les prelevements ont ete inclus en paraffine et colore a l'hemateine eosine. Resultats: Le cancer du rein de l'enfant representait 0.28de l'ensemble des cancers. Il y avait 18 garcons (52.94) et 16 filles (47.06). L'age moyen etait de 4.88 ans. Au plan histologique nous avons observe 31 cas de nephroblastome (91.18); 2 cas de lymphome de Burkitt (5.88) et 1 cas de carcinome a cellule renale (2.94). Conclusion: Les cancers solides du rein de l'enfant sont domines par le nephroblastome

Tumeurs malignes du testicule en Côte d'Ivoire: aspect anatomo-pathologique à propos de 54 cas

Objectif : Le but de cette étude est d'étudier les caractéristiques histologiques du cancer du testicule en Côte d'Ivoire. Matériel et méthodes : Cette étude rétrospective porte sur les dossiers de 54 patients âgés en moyenne de 23,41 ans (extrêmes 13 mois et 68 ans) avec des tumeurs malignes du testicule, colligés en 25 ans dans les services d'Anatomie pathologique de Côte d'Ivoire. Les renseignements suivants ont été évalués: l'âge, l'origine géographique des patients ainsi que les caractéristiques cliniques des tumeurs telles leur localisation, leur nature et leur type histologique. Certaines données telles que les marqueurs tumoraux et la stadification de la maladie n'ont pas été prises en compte. Résultats : En moyenne deux tumeurs ont été diagnostiquées par an. Sur le plan histologique, 87% des tumeurs sont primitives. On y distingue: 46,3% de tumeurs germinales parmi lesquelles les tumeurs germinales non séminomateuses sont prédominantes avec un taux de 24.07% de l'ensemble des cas et les séminomes 22.22% des cas; et 40.74% de tumeurs non germinales avec 18,5% de rhabdomyosarcomes. Les tumeurs secondaires représentent 13,9% des tumeurs du testicule de notre série. Il s'agit essentiellement de localisations secondaires des lymphomes de Burkitt (5 cas sur 7). Enfin, l'atteinte bilatérale est importante. La tumeur est bilatérale, d'emblée dans 31% des cas. Conclusion : Il ressort que les tumeurs du testicule sont rares en Côte d'Ivoire, avec une incidence annuelle d'environ deux cas. Elles surviennent chez l'adulte jeune âgé en moyenne de 23 ans et sont souvent de mauvais pronostic à cause de la bilatéralité de leur atteinte. En effet, 31% des tumeurs testiculaires atteignent simultanément les deux testicules

Sudden death caused by parasites: postmortem cerebral malaria discoveries in the african endemic zone.

This survey presents several cases of sudden deaths in Africa, specifically in Cote d'Ivoire, where the postmortem diagnosis of human cerebral malaria was determined after autopsy followed by pathologic examination of the brain. It is thought that cerebral malaria may be the primary cause of sudden death in nonimmunized persons during or after traveling in such endemic areas of Africa. The target population is composed of tourists, business travelers, and sailors. Because death caused by cerebral malaria occurs so suddenly, it can lead to forensic issues. Therefore, in any cases involving sudden death, it is very important for the forensic scientist to do a systematic evaluation, including pathologic examination of brain tissue, to rule in or exclude cerebral malaria. This practice will reinforce and aid research in progress directed at developing a vaccine and elucidating the role of tumor necrosis factor in this disease. Furthermore, this study will alert the physician to the importance of an effective and well-followed prophylaxis.

[The musculo-fascial graft from the elevator muscle of the anus. Importance for plastic surgery of the bladder in the treatment of obstetric vesico-vaginal fistulas]. / Le lambeau musculo-fascial du muscle élévateur de l'anus. Intérêt pour une plastie vésicale dans la crue des fistules vésico-vaginales obstetricales.

The levator ano-muscle and fascia are studied by females pelvis. The muscle is composed of three groups of fibres: the puborectalis muscle, the ilococcygeus and the ischiococcygeus muscles. The muscular fascial graft is dissected from the superior fibers of puborectalis muscle and placed in front of the lateral face of the bladder. In this regard, the anatomical and clinical knowledges are provided and morphometric and morphologic studies proposed this graft as the inter-vesico-vaginal plasty in treatment of vesico-vaginal fistulae.

[Malignant melanoma in the Ivory Coast. Epidemiologic and histo-prognostic aspects. Report of 195 cases]. / Mélanomes malins en Côte-d'Ivoire aspects épidémiologiques et histopronostiques. A propos de 195 cas.

Malignant melanomas (MM) are rare tumors of very bad prognosis. Few studies have precised the anatomopathological aspects and prognosis of these tumors in Africa and especially in Côte d'Ivoire. This has prompted us to review 195 cases of MM diagnosed in our laboratories in order to precise their epidemiological and anatomical features. Biopsies and/or surgical specimens fixed in 10% buffered formalin have been studied using the paraffin embedding methods and staining with hematoxylin and eosin, Masson's trichrome and Fontana. 117 men (60%) and 78 women (40%) with a medium age of 57 years were studied. Cutaneous MM were predominant (174 cases, 93%) with 57.8% located on the foot. Non classified (38.2%) and nodular (33.6%) forms were more frequent with only 19% of acral lentiginous melanomas. The prognosis of our cases was poor with 71% of levels IV or V according to Clark and Mihm, Breslow's thickness superior to 3 mm in 93% of cases and ulceration in 91.3%. Our study emphasizes the poor prognosis of MM in Côte d'Ivoire. These tumors are frequent in the elderly and located predominantly on the foot.

Distribution of measles virus in the central nervous system of HIV-seropositive children.

In an autopsy study the distribution of measles virus (MV) in the central nervous system (CNS) of 18 measles-infected children (13 HIV seropositive, 5 HIV seronegative), in Abidjan, Ivory Coast was examined using immunocytochemistry and in situ hybridization. Of these children 17 died from measles giant cell pneumonia. In 3 of the 13 HIV-seropositive patients MV antigens and genomic RNA was detected in the CNS. One of these positive patients had an MV encephalitis with abundant virus throughout most of the CNS. MV was not detected in the CNS of any of the 5 HIV-seronegative patients. These findings, albeit in a small number of cases, would suggest there may be an increased susceptibility to infection of the CNS with MV in HIV-positive children. In this respect entry and growth of MV in the CNS in HIV-seropositive individuals may be similar to the occurrence of measles inclusion body encephalitis in immunocompromised individuals. Furthermore, comparison of the HIV-MV encephalitis patient with two patients with subacute sclerosing panencephalitis (SSPE) demonstrated a paucity of virus in neuronal processes in the HIV-MV encephalitis. Unlike in SSPE, MV maturation by budding through the plasma membrane may occur, thereby minimizing build up of and intracellular movement of incomplete virus.

[Apropos of 1 Ivoirian case of osseus and cutaneous histoplasmosis by Histoplasma capsulatum var. duboisii]. / A propos d'un cas ivoirien d'histoplasmose osseuse et cutanée à Histoplasma capsulatum var. duboisii.

Humeral, tibial and cutaneous localizations of Histoplasma capsulatum var. duboisii were observed on a 6 year old boy. The diagnosis was made possible by anatomo-pathological and mycological examinations. Treatment with terbinafine was administrated for 4 months. The boy recovered without after-effects in the tibial localization, but did suffer after-effects in the humeral localization.

The neuropathology of HIV-infected African children in Abidjan, Côte d'Ivoire.

In an autopsy study of HIV-infected children in Abidjan, Côte d'Ivoire, the neuropathology of 76 HIV-1- and 2 HIV-2-positive children was compared with that of 77 frequency-matched HIV-negative children, in whom the systemic pathology was also known. Seventy of the 78 HIV-seropositive children were confirmed as HIV-infected, as determined by combined serology, IgA Western blots and clinicopathological criteria. The HIV-negative children showed a high background level (n = 49, 64%) of neuropathological abnormalities, including nonspecific inflammatory infiltrates, micromineralization, and bacterial and lymphocytic meningitis. In the HIV-positive children, HIV encephalitis was found in 4 (6%), cytomegalovirus in 2 (3%), toxoplasmosis in 3 (4%) and measles encephalitis in one (1%). Bacterial meningitis was equally common in both groups, but cerebral malaria was less common (n = 2, 3%) in HIV-positive than in HIV-negative children (n = 11, 14%). The low prevalence of HIV encephalitis may reflect comparatively early death in HIV infection in Africa as compared with our experience in Europe and the US.

Disease in children infected with HIV in Abidjan, Côte d'Ivoire.

OBJECTIVE: To document the range of disease in African children infected with HIV. DESIGN: Necropsy results in consecutive children aged 1 month or more who were HIV positive and in children who were HIV negative for comparison; IgA western blots on serum samples from children under 2 years of age who were positive for HIV-1 to test the validity of routine HIV serology. SETTING: Largest hospital in Abidjan, Côte d'Ivoire. SUBJECTS: 78 children who were HIV positive and 77 children who were HIV negative on whom a necropsy was performed; their median ages at death were 18 and 21 months respectively. 36 HIV positive children and 29 HIV negative children were 1-14 months old; 42 HIV positive and 48 HIV negative children were > or = 15 months old. MAIN OUTCOME MEASURES: Cause of death and prevalence of diseases confirmed pathologically. RESULTS: Respiratory tract infections were more common in HIV positive than in HIV negative children (73 (94%) v 52 (68%); P < 0.05), and were aetiologically heterogeneous. Pneumocystis carinii pneumonia was found in 11 out of 36 (31%) HIV positive children aged < 15 months, but in no HIV negative children. Among older children measles was more common in HIV positive children (8/42 (19%) v 2/48 (4%); P < 0.06). Pyogenic meningitis was present in similar proportions of HIV positive and HIV negative children aged < 15 months (7/36 (19%) and 7/29 (24%)). In HIV positive children tuberculosis (1/78), lymphocytic interstitial pneumonitis (1/78), and HIV encephalitis (2/78) were rare. CONCLUSIONS: There is greater overlap between diseases associated with HIV infection and other common health problems in African children than there is in adults. Compared with adults, HIV positive children had a high prevalence of P carinii pneumonia and a low prevalence of tuberculosis. Measles, but not malaria, was associated with HIV infection.

HIV-associated lymphoma in Africa: an autopsy study in Cote d'Ivoire.

HIV infection predisposes to the development of non-Hodgkin lymphoma (NHL). The frequency of NHL among HIV-positive adults and children in sub-Saharan Africa is not known. In 1991-1992, a representative autopsy study of HIV infection was performed in Abidjan, Côte d'Ivoire. Of 247 HIV-positive adult (> 14 years) medical patients dying in hospital, 2.8% had NHL, 1.6% with visceral NHL and 1.2% with primary cerebral lymphoma. The estimated crude incidence of NHL among HIV-positive adults in Abidjan was 84/100,000 per year, 10-fold greater than the expected pre-AIDS incidence of NHL but less than the incidence observed among HIV-positive adults in industrialised countries. None of 78 autopsied HIV-positive children (median age = 17 months) had NHL. HIV infection augments the incidence of NHL among adults in Africa, but short survival with advanced HIV disease probably prevents the major increase in HIV-associated NHL seen in industrialised countries. Survival of HIV-positive children in Africa appears too short to permit the significant development of additional NHL; classic Burkitt lymphoma is not an AIDS-associated tumour in Africa.

Contribution of tuberculosis to slim disease in Africa.

OBJECTIVES: To assess the contribution of tuberculosis to the aetiology of the HIV wasting syndrome (slim) in Africa, a condition usually considered an enteropathy. METHODS: Clinical examination and representative necropsy study of adult patients positive for HIV. SETTING: Hospital medical wards in Abidjan, Ivory Coast. SUBJECTS: Adults positive for HIV. MAIN OUTCOME MEASURES: CD4 T lymphocyte counts before death, clinical and anthropometric data, and gross and microscopic pathology. RESULTS: Necropsy was done on 212 HIV positive adults. Tuberculosis was found in 41 of 93 with the clinical HIV wasting syndrome and in 32 of 119 without (odds ratio 2.1, 95% confidence interval 1.2 to 4.0). A significant association existed between the prevalence of tuberculosis at necropsy and the degree of cadaveric wasting (no wasting 25% (15/59); moderate wasting 40% (23/58); skeletal wasting 44% (42/95); P = 0.02). Wasting was also associated with a history of chronic diarrhoea, but no association existed between diarrhoea and tuberculosis. Median CD4 T lymphocyte counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhoea (< 60 x 10(6)/l). CONCLUSION: Wasting and chronic diarrhoea are late stage manifestations of HIV disease in Africa. The importance of tuberculosis as a contributing factor in the pathogenesis of the slim syndrome has been underestimated. In nearly half of patients dying with severe wasting, tuberculosis was the dominant pathological finding.

PIP: The authors explore the contribution of tuberculosis (TB) to the etiology of HIV wasting syndrome in Africa, usually considered to be an enteropathy. Clinical examinations and necropsy were performed upon 212 HIV positive adults in the medical wards of the largest hospital in Abidjan, Cote d'Ivoire. TB was found in 41 of 93 patients with the clinical wasting syndrome and in 32 of 119 without. Significant associations were found between the prevalence of TB at necropsy and the degree of cadaveric wasting, moderate wasting, and skeletal wasting. Wasting was also associated with a history of chronic diarrhea, but no association existed between diarrhea and TB. Median CD4 counts were lowest in wasted patients irrespective of findings at necropsy and in those with chronic diarrhea. The authors note that wasting and chronic diarrhea are late stage manifestations of HIV disease in Africa and argue that researchers and practitioners have underestimated the importance of TB as a contributing factor in the pathogenesis of slim disease.

The mortality and pathology of HIV infection in a west African city.

BACKGROUND: HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear. METHODS: Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied. RESULTS: Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis. CONCLUSIONS: In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.

[Clinico-pathologic aspects of rhinosporidiosis in the Ivory Coast. Report of 9 cases observed over 18 years]. / Aspects anatomo-cliniques de la rhinosporidiose en Cote d'Ivoire. A propos de 9 cas observés en 18 ans.

The authors report 9 cases of rhinosporidiosis observed in Côte d'Ivoire. Young subjects are generally concerned with E.N.T. and eye manifestations. There is a male preponderance. Pathological aspects are classical. Surgery has been the only treatment with good results.

[Pleomorphic adenoma of the salivary glands. Analysis of 41 cases and the causes of recurrence in the Ivory Coast]. / Adénomes plémorphes des glandes salivaires. Analyse de 41 cas et des causes de récidive en Côte-d'Ivoire.

Based on a study of 41 cases, the authors report the high incidence of myxo-chondroid varieties on histological examination and their relationship to recurrences attributed to potential changes in myo- epithelial cells.

[Cylindroma of the salivary glands. Various aspects apropos of 10 cases from the Ivory Coast]. / Cylindromes des glandes salivaires. Quelques aspects à propos de 10 cas observés en Côte-d'Ivoire.

It was found that accessory salivary glands involvement, in particular intra-maxillary, was most frequent in a study involving 10 cases. Only basaloid varieties have a very poor prognosis and surgery remains the only treatment available.