Malignant peripheral nerve sheath tumor of the superficial cervical plexus with parotid extension.

INTRODUCTION: Cervical locations of malignant peripheral nerve sheath tumor (MPNST) are rare, at less than 1% of malignant tumors of this region. CASE REPORT: A 53-year-old woman presented with a lateral cervical swelling involving the parotid region. Histology was in favor of MPNST. Adjuvant radiotherapy was indicated because of the infiltrating nature of the tumor. At 2 years' follow-up, there was no recurrence. DISCUSSION: Clinical diagnosis is difficult in cervical MPNST. Only histology with immunohistochemistry can establish the correct diagnosis. Treatment requires complete surgical resection and regular clinical follow-up.

[Imaging in the screening and diagnosis of hepatocellular carcinoma in cirrhosis liver in Tunisia. A series of 30 cases]. / L'imagerie dans le dépistage et le diagnostic du carcinome hépatocellulaire sur foie de cirrhose en Tunisie. A propos de 30 cas.

UNLABELLED: The aim of our study is to expose a practical screening and diagnosis strategy of HCC occuring in cirrhosis liver, which is nowadays a health public matter in Tunisia. METHODS: HCC routine screening in cirrhosis liver has been conducted every 6 months using a combination of abdominal sonography and serum alpha-foetoprotein levels. PCUS, CT scan or MRI have been performed each time a focal liver lesion was discovered in US, or in case of elevated serum alpha-foetoprotein levels. 30 cases of HCC were identified. RESULTS: US has shown a unique nodule in 46% of the cases, multiple nodules in 50% of them. No lesion has been discovered in 4% of the cases. Nodule size ranged from 8 to 140 mm. Heterogenous hyperechoic pattern was the most frequent one (41%). Hypervascular doppler feature was authentified in 20% of the cases. Serum alpha-foetoprotein levels had respectively a sensitivity and a specificity of 14% and 44% in lesions inferior to 3 cm, 62% and 80% in lesions superior to 3 cm. Typical arterial enhancement of HCC was depicted in 1 case for PCUS, in 76% for CT scan and 60% for MRI. CONCLUSION: Combination of abdominal sonography and serum alpha-foetoprotein levels practiced every 6 months represent a good compromise between cost and effectiveness. Second intention imaging is based on CT scan in Tunisia because of its availability compared to MRI. PCUS is becoming in the near future the best modality for lesion caracterization thanks to its safety and relative inexpensiveness.

[Melanotic schwannoma of the temporozygomatic region]. / Schwannome mélanocytique de la région temporozygomatique.

INTRODUCTION: Melanotic schwannoma is a rare benign tumor, which arises from nerve sheath cells. Melanotic differentiation is its most histologic characteristic. CASE REPORT: We report a case of melanotic schwannoma arising in the temporozygomatic region for a man of 38-year-old. Outcome was favourable after tumor resection. DISCUSSION: This benign neoplasm occurs pronominally in spinal nerve roots. Craniofacial locations are rare. Most melanotic schwannomas are slow growing tumors, but prognosis can be poor because of local recurrence or malign behavior, especially when multiple lesions are present and/or involve the Carney complex.

[Pituitary and ovarian mass syndrome in primary hypothyroidism]. / Syndrome de masse hypophysaire et kystes ovariens dans un cas d'hypothyroïdie périphérique.

INTRODUCTION: Hyperprolactinemia and a pituitary mass syndrome can occur in patient with primary hypoyhroidism. In young women, hypothyroidism can be associated with ovarian cysts. EXEGESIS: We report a case of a 30 year-old women who was treated for an anemia. She had clinical and biological signs of primary hypothyroidism with hyperprolactinemia at the biology. Pituitary MRI showed a pituitary mass. The pelvic ultrasound examination and CT scan showed a right ovarian cyst. The subsequent thyroid hormone replacement was associated with a clinical, a biological and radiological resolution. It was a pituitary and ovarian mass syndrome secondary to primary hypothyroidism. CONCLUSION: The recognition of these associations may eliminate unnecessary surgery and lead to the choice of hormone replacement therapy.

[Parotid haemangioma: MR imaging findings in 3 cases]. / Hémangiome parotidien: aspects IRM. A propos de trois cas.

OBJECTIVE: Parotid gland hemangioma is uncommon in infancy and childhood and even rarer in adulthood. The clinical presentation, supported by imaging findings provides the diagnosis. The aim of this work is to discuss the different clinical and radiological aspects of this lesion with a special emphasis on MRI findings. METHODS: Three patients with unilateral hemangioma are presented. Radiological investigations including ultrasound and magnetic resonance imaging (1 Tesla) were performed. RESULTS: Sonographic studies showed a lobulated mass with intermediate echogenicity, enlarging most or all of the visualized parotid gland. Correlative MR images in all cases showed a well-defined mass with an intermediate signal on T1-weighted images. On T2-weighted images, all masses appeared bright, heterogeneous with low signals within the masses consistent with flow voids representing blood vessels. Phleboliths were present in one case. CONCLUSION: MRI is the investigation of choice allowing an accurate diagnosis and avoiding invasive procedures including biopsy.