[African histoplamosis. A report of three pediatric cases]. / Trois cas pédiatriques d'histoplasmose africaine à Brazzaville.

Histoplasmosis duboisii (Histoplasma capsulatum var duboisii) is uncommon disease especially in children. It is observed in Africa where the incidence is unknown. The authors report a series of three pediatric cases. The report concerned 2 girls and one boy who were 3, 9 and 4 year-old, respectively. Symptoms evolved for more than two months in each case. At admission, we found fever and poor general condition. Observed lesions were lymphnodes localisation disseminated (cases 1 and 2), subcutaneous (cold abscess) and cutaneous simulating molluscum contagiosum (case 2), osteoarticular (cases 2 and 3), abdominal including peritoneal and hepatosplenic (case 1). In all cases, a mild leukocytosis was found and an accelerated erythrocyte sedimentation rate (ESR) greater than 70mm. The HIV serology was negative. The treatment consisted of itraconazole in 2 cases and ketoconazole in one case. The evolution was insidious, leading to the discharge against medical advice. The death occurred at home in all cases. CONCLUSION: Histoplasmosis duboisii can realize two main clinical presentations (localized or disseminated), affecting the skin, lymph nodes, bones, sometimes the intra-abdominal organs. HIV serology is not always positive in disseminated forms. The evolution is unpredictable and capricious under antifungal treatment. The disease should be well explained to prevent a possible discharge against medical advice, often pejorative.

Tumeur d'Abrikossoff de l'estomac : une localisation rarissime

La tumeur d'Abrikossoff ou tumeur à cellules granuleuses est une lésion rare, souvent unique et bénigne. L'âge de son diagnostic habituellement est compris entre 40 et 60 ans. Elle prédomine légèrement chez les femmes, notamment de race noire. Elle est de siège ubiquitaire et préférentiellement cervico-céphalique. La langue reste la localisation la plus fréquente avec 28% des cas. Les autres localisations sont beaucoup moins fréquentes. Nous rapportons le premier cas documenté au Congo Brazzaville, de localisation gastrique, suivi d'une revue de la littérature

Le psoriasis lingual. A propos d'une observation

Introduction : Le psoriasis est une pathologie inflammatoire chronique. Même si ses manifestations cutanées sont connues et décrites, les données sur l'implication orale restent limitées et rares. Nous rapportons dans ce travail une observation de psoriasis lingual, dans le but de rappeler une expression clinique inhabituelle de cette pathologie. Observation : Il s'agit d'un garçon de 16 ans qui présentait de façon chronique, une gêne alimentaire avec des douleurs linguales. Dans les antécédents, on retrouve des lésions cutanées, érythémateuses prurigineuses, surmontées de squames, prédominants sur les genoux, la face antérieures des jambes et le dos de la main. L'examen de la cavité buccale mettait en évidence, la présence de fissures avec multiples sillons sur la face dorsale de la langue. Le traitement associait des dermocorticoïdes, des bains de bouche, la polyvidone iodée, des tamponnades linguales et des histaminiques. Conclusion : Le psoriasis est une affection dermatologique chronique rare qui est resté longtemps ignoré. Les principales manifestations cliniques sont la langue géographique et la langue fissurée. Son traitement est aisé et le pronostic est heureusement bénin dans l'immense majorité des cas

Cancer de la prostate : Corrélation entre le taux de PSA et le score de Gleason

Objectif : Evaluer la corrélation entre le taux de PSA et le score de Gleason. Patients et méthode : Il s'est agi d'une étude rétrospective où ont été retenus les malades ayant un diagnostic histologique de cancer de la prostate avec score de Gleason et un taux de PSA total initial. Trois groupes de différenciation ont été constitués. Le taux de PSA a été regroupé en six classes : < 10 ng/ml, [10-50 ng/ml], ]50-100 ng/ml], ]100-500 ng/ml], ]500-1000 ng/ml], >1000 ng/ml. Le test de Fisher et un modèle de régression logistique ont permis d'apprécier la corrélation entre le taux de PSA et le score de Gleason. Résultats : Soixante-deux cas ont répondu aux critères d'inclusion. L'âge moyen était de 66 ans (extrêmes 49-80 ans). Dans 83,9% le taux de PSA variait entre 10 et 500 ng/ml. Cinquante virgule cinq pour cent (50,5%) avait un score de Gleason compris entre 8-10. Les taux de PSA variaient entre 3 et 3025 ng/ml avec une médiane à 68,5 ng/ml, une moyenne à 211,37 ng/ml et un écart-type de 474,05 ng/ml. Le taux moyen de PSA était de 42,39 ng/ml pour les cancers bien différenciés, 222,8 ng/ml pour les cancers moyennement différenciés, et 249,09 ng/ml pour les cancers peu différenciés. La probabilité d'avoir un cancer bien différencié diminuait significativement avec l'augmentation du taux de PSA selon un rapport de cotes variant entre 1,46 et 1,82 (p = 0,029). Conclusion : Le taux de PSA pourrait permettre de prédire le grade de différenciation du cancer de la prostate mais pas le score de Gleason. Cette prédiction pourrait être améliorée en tenant compte du stade d'extension du cancer

[Prostate cancer: Gleason scores correlation between biopsies and surgical gross specimen]. / Cancer de la prostate : corrélation des scores de Gleason entre les biopsies et les pièces opératoires.

UNLABELLED: The Gleason score is a histopronostic criterion which gives an appraisal of prostate cancer aggressiveness and outcomes. OBJECTIVE: The goal of this retrospective study was to assess the relationship between Gleason scores appreciated on biopsies and later on surgical gross specimen. RESULTS: During the period of the study, 123 patients benefit of a histological diagnosis of prostate cancer recording Gleason score on biopsies and postsurgical intervention on gross specimen. After analysis of biopsies and for gross specimen the reported Gleason scores vary from 3 to 9 and the mean was 5.9 and 6.1 respectively. There was a good concordance between the Gleason scores for biopsies and gross specimen in about 32.5% of cases. We noted a difference of score of one point in 37.3% of patients and a difference of two points and more in 30% of cases. In 28.4% the Gleason scores were overestimated while in 39% they were underestimated. More than half of the patients' cohort was classified in the group of histologically moderately differentiated cancer. When grouping the patients according to the histological types well, moderately or less differentiated cancers, the Gleason scores concordance for biopsies and for gross specimen change from 32.5% up to 74.8%. The correlation can be considered good for the less differentiated cancers. CONCLUSION: Gleason score showed some limits in the appreciation of the prediction. The grouping of patients according to the three distinct histological differentiation groups increases the concordance between the score of Gleason on biopsy specimen and gross specimen but it seems less powerful for cancers well and moderately differentiated cancers.

[A case of isolated tuberculosis of the appendix at the University Hospital Center in Brazzaville, Congo]. / Une observation de tuberculose isolée de l'appendice au Centre Hospitalier et Universitaire de Brazzaville.

Since the outbreak of human immunodeficiency virus (HIV) infection, extrapulmonary tuberculosis has become increasingly frequent in developing countries. The purpose of this report is to describe a case of isolated tuberculosis of the appendix diagnosed following generalized peritonitis in a 53-year-old man. The appendix is the least frequent gastrointestinal location of isolated tuberculosis. Diagnosis was achieved by histopathological examination of the appendix immersed in formalin 10% after appendectomy. Paraffin-embedded histological sections stained with hematoxylin-eosin (HE) displayed caseofollicular lesions characteristic of infection by Koch bacillus. Outcome was favourable with a 9-month regimen of antituberculosis treatment according to the protocol of the World Health Organization (WHO).

Une observation de tuberculose isolee de l'appendice au centre hospitalier et universitaire de Brazzaville

La tuberculose extrapulmonaire est; dans les pays en voie de developpement; de plus en plus frequente avec l'avenement de l'infection au virus de l'immunodeficience humaine (VIH). Les auteurs rapportent l'observation d'un homme de 53 ans immunocompetent ayant presente une tuberculose isolee de l'appendice revelee par une peritonite generalisee. Cette atteinte isolee de l'appendice est la moins frequente parmi les localisations viscerales digestives. Le diagnostic anatomo-pathologique etait fait sur la piece d'appendicectomie immergee dans du formol a 10

[Cutaneous B-cell lymphoma in a 50 year old woman at Brazsaville University Teaching Hospital]. / Localisation cutanee d'un lymphome B chez une femme de 50 ans au CHU de Brazzaville.

The authors report one case of no epidermotropic cutaneous B-cell lymphoma on 50-year-old female patient, with acute evolution, presenting cutaneous, spleen, peritonea and ophthalmologic multiple nodular lesions, diagnosed while a knee staphylococcus aureus septic arthritis.

[Pathological fracture revealing an osseous histoplasmosis. A case report on a 60-year patient]. / Fracture pathologique révélant une histoplasmose osseuse. A propos d'une observation chez une patiente de 60 ans.

The authors report a new case of African Histoplasmosis in a 60-year-old patient. It was an humeral localization revealing a pathological fracture which grew into an extension of osteolysis and a cutaneous fistulization likely to be a malignant bone tumor. The case has been diagnosed by surgical biopsy and histological analysis. Its antifungal treatment in progress resulted in the drainage of the out-flow that should permit the bone reconstruction by graft. The authors stress on the need to focus on this affection whenever, in a tropical area, one is faced with any chronic bone fistula that cannot positively be cured in spite of sound medical cares.

[Orbital diseases in Brazzaville University Hospital (Congo)]. / Profil des affections orbitaires au Centre Hospitalier et Universitaire de Brazzaville, Congo.

PURPOSE: The aim of our study was to determine the occurrence of different orbital diseases. PATIENTS AND METHODS: The authors report the results of a retrospective survey of 704 patients examined over 9 years, from January 1981 to December 1989. We used J. Rootman's physiopathologic classification. The inclusion criteria included clinical examination, essential paraclinical explorations, and X-rays. Data frequencies and homogeneity were analyzed with the chi 2 test. RESULTS: Orbital diseases made up 7.04+/-0.02% of the eye pathologies found. A male prevalence was noted (p<0.05). The distribution according to age groups was characterized by a bimodal curve with a peak at very early childhood and another at the 30s and 40s (p<0.05). Etiologies were as follows: inflammatory diseases and exophthalmia (61.7%), trauma and structural lesions (24.7%), degenerative diseases (3.7%), tumors (3.7%), and blood and vascular diseases (2.4%). Inflammations and orbital injuries occur more often among men and exophthalmia among women (p<0.05). According to age, inflammations, injuries, degenerative diseases, and malformations occur between 0 and 20 years, and inflammations, degenerative diseases, injuries, and tumors occur with greater frequency after 20 years (p<0.05). DISCUSSION: Inflammations, injuries, and tumors are the principal diseases of the orbit diagnosed. The different occurrences of tumors and specific inflammations observed in this study are related to the inadequate means of complementary examinations and the difficult access to health care centers in African countries.

[Inverted naso-sinusal papilloma: analytic study on 13 cases]. / Papillomes inversés naso-sinusiens: etude analytique de 13 cas.

OBJECTIVES: Inverted nasosinusal papilloma is a rare tumorous process involving mucosa of nasal fossa and paranasal sinus unilaterally. The authors studied inverted naso-sinusal papilloma observed and treated in ENT and Head and Neck department at Brazzaville University Hospital. MATERIAL AND METHODS: Retrospective study concerning 13 patients treated between 1988 and 2001. RESULTS: The average age is 34 years (range: 16 to 60 years); old nasal obstruction is the main symptom (12 cases); the diagnosis is histologic; association with Killian polyp (1 case), human papilloma virus infection (1 case) and rhinosporidiosis (1 case); large surgical removal (Caldwell-Luc, para-latero-nasal) and polypectomy associated to diathermy of tumorous insertion place permitted to have satisfactory results; the recurrencies were observed in four cases from 7 months to 10 years (average: 4 years); malignant transformation is noted in 2 cases with one case of inverted papilloma combined to Human Papilloma Virus infection. CONCLUSION: All naso-sinusal polypoid should have a histological study. Patients must be followed-up regularly; this is very difficult in Africa.

[Cysts and congenital fistulas of the face and the neck. About 78 cases]. / Kystes et fistules congénitaux de la face et du cou. A propos de 78 cas.

The cysts and congenital fistulas of the face and neck induce frequent malformations in Oto-Rhino-Laryngology. A retrospective study on these malformations has been carried out from January 1986 to December 2001 in the Oto-Rhino-Laryngology unit of the Brazzaville Teaching Hospital. This study considered the epidemio-clinical aspects, the modes of therapeutic treatment and the evolution of these congenital pathologies. The cysts and congenital fistulas represented 2% of the consultations in the service. Patients were aged of 10 months to 50 years (average age: 21 +/- 5 years) among them 49 men (63%) and 29 women (37%). The pathology appeared in childhood in 41% of the cases and during adult age in 59% of the cases. The main circumstances of discovery were: cystic swelling (72%), infectious complication (18%) and productive fistula (10%). The clinical forms have been dominated by the cysts of the thyreoglossal tractus (72%), followed by the pre-auricular fistulas (10%), the amygdaloid (9%), dermoid (6%) and nasopalatine (3%) cysts. The treatment was in any case surgical. A good embryo-pathogenic knowleldge should contribute to a complete surgical exeresis, a necessary condition to avoid recurrence.

[Thyroid disorders in the Brazzaville Teaching Hospital]. / La pathologie thyroïdienne au Centre hospitalier universitaire de Brazzaville.

The authors report their experience with thyroid disorders. Between January 1994 and December 2003, a total of 567 patients (sex ratio: 1/20, men to women) with thyroid disease were examined in the endocrine and metabolic department of the Brazzaville Teaching Hospital. Their mean age was 43 years. 333 (58.7%) had a simple goiter, 118 (20.8%) hyperthyroidism, most often related to Graves' disease (60.8%). Other disorders included multinodular goiters (19.2%), toxic adenoma (7.1%) and thyroiditis (13.8%). Hypothyroidism was identified in 7.4% of cases, mainly following thyroid surgery. Thyroid cancer was rare (4 cases).

[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.

[The first Congolese case of cervical clear cell adenocarcinoma]. / Première observation congolaise d'un adénocarcinome à cellules claires du col de l'utérus.

The authors report the first Congolese case of uterine cervix clear cell adenocarcinoma in a menopausal multipara, whose mother had not been treated by diethystilboestrol (DES). The histological diagnosis was made on embedded-paraffin samples, stained by HE and PAS. Discharged from hospital on parents' request in order to be on infusion and brew-based traditional treatment, the patient died at home two months after diagnosis.

[Malignant solid tumours in Brazzaville children: epidemiological and anatomo-pathological aspects]. / Les tumeurs solides malignes de l'enfant à Brazzaville: aspects épidémiologique et anatomo-pathologique.

In this retrospective study over six years the authors report 65 malignant solid tumours of the children under the age of 15 years old. The average age was 7.9 years with a peak of frequency between 5 and 9 years. There was a male prevalence with a sex-ratio of 1.3. The most frequent histological types were: lymphoma of Burkitt (52%), retinoblastoma (20%), nephroblastoma (9%) and malignant tumours of the soft tissues (6%). The malignant solid tumours of the child are relatively rare and histologically very diversified.

Un cystadenocarcinome mucineux du pancreas chez une adolescente de 17 ans a Brazzaville

Les cancers du pancreas exocrines sont rares et domines par les adenocarcinomes. Une adolescente agee de 17 ans; suivie pendant deux mois pour pancreatite chronique; a progressivement presente un tableau fait d'alteration de l'etat general et d'une masse abdominale. Les explorations entreprises; l'examen fait en per-operatoire ont permis de conclure au diagnostic de cystadenocarcinome de la tete du pancreas. C'est cette observation; dont l'evolution a ete rapidement mortelle; qui est rapportee ici

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