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Le pancreas ectopique (ou aberrant ou heterotopie pancreatique) se definit par la presence de tissu pancreatique en situation anormale, sans rapport anatomique avec la glande principale. Son incidence est estimee entre 0,5% et 14% sur les series autopsiques, mais est probablement sous-estimee du fait de son caractere le plus souvent asymptomatique. Les localisations habituelles sont representees par le duodenum (30-35%), l´estomac (30%) et le jejunum (15%). Sa localisation hepatique est exceptionnelle. Nous en rapportons un nouveau cas de decouverte fortuite. Il s´agit d´une patiente âgee de 54 ans, hypertendue, operee deux ans auparavant pour un adenocarcinome du sigmoide classe pT3N1b (A). L´evolution etait marquee par l´installation de multiples nodules d´allure secondaire predominant au niveau du lobe hepatique droit (B), d´ou l´instauration d´une chimiotherapie neo-adjuvante (4 cures FOLFOX-ERBITUX). La patiente a beneficie d´une lobectomie droite. L´examen histologique des differents prelevements effectues a confirme la presence d´une localisation secondaire hepatique d´un adenocarcinome moyennement differencie d´origine colorectale avec des limites d´exereses saines. Le foie alentour etait le siege d´une steatose macrovacuolaire non systematisee estimee a 20%. Il s´y associait un foyer d´heterotopie pancreatique englobant des acini et des canaux excreteurs organises en lobule (C, D). Les suites operatoires immediates etaient simples, cependant, l´evolution a ete marquee par la recidive tumorale au niveau du foie gauche.

Tuberculosis arthritis on prosthesis is mainly the consequence of a local reactivation of a tuberculosis infection. The clinical characteristics are broadly identical to those of other infections on prostheses except that the clinical course is often chronic, with sometimes repeated loosening when the infection has been overlooked and the presence of cold abscesses and fistulization at the skin is not uncommon. Fistulas can become infected with a common germ, which can delay the diagnosis of tuberculosis. This is the case of a 51-year-old man operated on in 2001 for a total hip prosthesis, in whom the radiological check-up revealed a mechanical loosening of the prosthesis. A surgical re-intervention was decided for this patient. Intraoperatively, rice-like granules were discovered next to the acetabulum. Histological examination of the periprosthetic samples taken showed that the rice-like granules responded to coalescent nodular formations surrounded by dense collagenous fibrosis and centered by an eosinophilic acellular amorphous necrosis. Giant scattered Langhans cells were focally noted. The final pathological diagnosis was that of caseo-fibrous tuberculosis. The patient received anti-tuberculosis treatment. He is currently undergoing orthopedic consultation. The clinician must think about tuberculous arthritis in case of mechanical loosening of a prosthesis. It is therefore essential to take microbiological samples, to look for BAAR with culture in a specific environment in search of mycobacteria. The pathological examination confirms the diagnosis with certainty.

L'hemangiome osseux est une lesion primitive benigne de l'os, caracterisee par la neoformation et l'agglomeration de vaisseaux sanguins anormaux. L'atteinte des vertebres et du squelette cranio-facial est la plus frequente mais, tous les os peuvent etre leses. Sa localisation au niveau de l'astragale est rare. Il s'agit d'une patiente âgee de 71 ans sans antecedents pathologiques notables, qui avait consulte pour des douleurs de la cheville evoluant depuis deux ans. La tomodensitometrie du pied a objective une image lytique et une fracture de l'astragale ainsi qu'une perte de substance interne osseuse. Une biopsie chirurgicale de cette lesion a ete pratiquee. Macroscopiquement, nous avons recu un materiel hemorragique, friable. Histologiquement, il s'agissait d'une proliferation vasculaire benigne, constituee de cavites vasculaires plus ou moins gorgees d'hematies et revetues d'une assise de cellules endotheliales aplaties. Il n'y avait pas d'atypies cytonucleaires ni d'activite mitotique anormale au niveau des cellules endotheliales. Sur le plan immunohistochimique ces cellules exprimaient le CD34. Le diagnostic retenu etait celui d'un hemangiome osseux. Les hemangiomes localement agressifs peuvent etre confondus, cliniquement et a l'imagerie, avec un processus malin, vasculaire ou non. L'histologie apporte la confirmation diagnostique. Cette tumeur est generalement stable, parfois spontanement resolutive en quelques annees. Elle peut cependant aussi avoir une evolution agressive localement.

Pseudoangiomatous stromal hyperplasia (PASH) is an uncommon benign proliferation of fibrous stroma, containing slitlike pseudovascular spaces lined by myofibroblasts. Less than 200 cases of PASH have been described in the English literature with the largest series including 40 cases. A 48-year-old woman with no particular past medical history, presented with a complaint of a slow, progressive, painless left breast mass. The patient underwent mammography which revealed a well delineated left breast nodule with microcalcifications classified BI-RADS 4. An excisional biopsy was performed on the mass to confirm the histological diagnosis. The specimen was a well-circumscribed whitish tumor measuring 3 x 3 cm with several microcysts (A). Histological examination revealed proliferation of fibrous stroma, with spindle cells and a network of slit-like empty clefts within acellular hyalinized stroma (B). The spindle cells were positive for CD34 and smooth muscle actin but were negative for Factor VIII. The final pathological diagnosis was nodular PASH. Postoperative course was uneventful and the patient is still being followed-up.

The pancreas is an unusual site for tumor metastasis, accounting for only 2 to 5% of all malignancies affecting the pancreas. A 67-year-old woman with a past medical history of right renal nephrectomy for renal cell carcinoma, eleven years ago, presented with nausea, diarrhea and vertigo. On admission, the patient was pale. Laboratory tests showed a low hemoglobin level (6,4 grams per deciliter). Abdominal ultrasonography revealed a well-defined, hypoechoic, homogeneous, vascular, lobulated mass in the tail of the pancreas. Computed tomography scan demonstrated a hypervascularized tumor of the pancreatic tail. The patient subsequently underwent a distal pancreatectomy with splenectomy. Grossly, the pancreatic mass was well-delineated and encapsulated measuring 9,5 x 6,5 cm and showed extensive hemorrhage (A). Histological examination of the surgical specimen revealed that the pattern of the tumour growth was predominantly solid, with formation of large nests and acini of tumor cells separated by a stroma that was endowed with prominent sinusoid-like vessels (B). The tumour cells were large ranging from optically clear, with sharply outlined boundaries, to eosinophilic tumour cells. The final pathological diagnosis was metastatic clear-cell renal carcinoma to the pancreas. Four peripancreatic lymph nodes were free of the tumor but the pancreatic resection margins were invaded by the tumour. Postoperative course was uneventful. Renal cell carcinoma metastasis should be considered in patients with a pancreatic mass as it gives the past history of renal cell carcinoma. Awareness of this entity and a high index of suspicion would help in proper diagnosis and treatment.

Young people under the age of 40 with colorectal cancer represent a distinct subgroup with a more aggressive disease behaviour compared to older patients. This study aim to provide an updated overview on clinicopathological features, treatment and outcome of colorectal cancer in young adults under the age of 40. In our retrospective study, we reviewed 32 cases of colorectal cancer in young adults aged less than 40 years that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (April 2000 - November 2014). Our study group included 13 male and 19 female patients (sex-ratio M/F = 0,68) between 17 and 39 years of age (mean = 31,25 years). The presenting clinical symptoms were dominated by altered bowel habits (n=17), followed by bleeding per rectum (n=16). Histopathological examination of the surgical and biopsy specimens established the diagnosis of mucinous adenocarcinoma in nine cases, well-differentiated adenocarcinoma in 11 cases, moderately differentiated adenocarcinoma in six cases, poorly differentiated adenocarcinoma in four cases and signet ring cell carcinoma in two cases. The tumours were classified after surgery as stage I (n = 2) (6%), stage IIA (n = 7) (22%), stage IIB (n=4) (13%), stage IIC (n=1) (3%), stage IIIB (n=8) (25%), stage IIIC (n= 4) (12%), stage IVA (n=4) (13%) and stage IVB (n=2) (6%). During the follow-up period which ranged between one month and 9 years, local recurrence of the tumour occurred in six cases, seven patients had hepatic metastases and seven patients died after a mean follow-up period of seven months. Molecular genetic studies are increasing the understanding of the pathobiology of colorectal cancer and may ultimately allow at-risk patients to be identified at an earlier stage.

Gallbladder adenomas are rare, but well-documented benign epithelial tumors. They are usually found incidentally in cholecystectomy specimens or during preoperative imaging studies. Although they are usually asymptomatic, they may present as a result of associated symptomatic gallstones, or from cystic duct obstruction due to large adenoma. Three subtypes of adenoma are defined: tubular, papillary and tubulopapillary and they are further classified histopathologically as pyloric gland, intestinal and biliary types. Most adenomas found in the gallbladder are pyloric gland type. A 52-year-old woman suffering from aspecific upper abdominal pain was admitted in the surgery department of our hospital. Physical examination did not reveal any abnormalities nor did routine blood testing. Abdominal ultrasonography showed a polypoid lesion in the gallbladder measuring 1.5cm long. Laparoscopy was performed showing normal anatomy of the gallbladder and surroundings. The gallbladder as well as the Mascagni lymph node were removed. Macroscopic examination of the gallbladder revealed a polypoid lesion in the gallbladder body measuring 1.5cm in diameter (A). On microscopy, the polypoid lesion was almost entirely made up of tightly packed pyloric type tubular glands with little intervening stroma (B). In the background gallbladder epithelium there were no abnormalities. Recovery after surgery was uneventful and the symptoms did not recur.

Hepatocellular carcinoma (HCC) is the most common of all liver cancers and is a major worldwide public health problem. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of HCC. In our retrospective study, we reviewed 64 cases of HCC that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (2000- 2014). Relevant clinical information and microscopic slides were retrospectively reviewed. Our study group included 38 men and 26 women (sex ratio M/F = 1,26) aged between 8 and 83 years (mean = 56,64 years). The presenting clinical symptoms were dominated by abdominal pain (n=34), followed by altered general health (n=25) and jaundice (n=4). Fifty-five patients underwent surgical treatment. Liver transplantation was performed in two cases and transarterial chemoembolization was achieved in seven cases. Histopathological examination of the surgical or biopsy specimen established the diagnosis of conventional HCC in 55 cases, fibrolamellar carcinoma in 6 cases and clear cell HCC in 3 cases. Seven patients with HCC died postoperatively. Local recurrence of the tumour occurred in three cases and two patients had distant metastases postoperatively. The other patients are still being followed-up. Hepatocellular carcinoma is associated with a high rate of mortality because of early invasion, widespread metastasis and lack of effective therapeutic modalities. Accurate diagnosis and staging of these tumours is critical for optimal treatment planning and for determining prognosis.Keywords: Liver, hepatocellular carcinoma, cancer, pathology

Solid pseudopapillary tumour (SPT) is an unusual pancreatic neoplasm which predominantly affects young women. Less than 10% of patients with SPT in the reported literature were male. In this paper, the authors report two new cases of SPT that occurred in two male patients aged respectively 25 and 20 years old. Abdominal computed tomography scan showed a well-defined heterogeneous mass involving respectively the tail and the body of the pancreas with peripheral calcifications in the first case. The two patients underwent distal splenopancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study was compatible with solid pseudopapillary tumour. On postoperative day 8, the first patient developed abdominal wall abscess and peritoneal collection. Postoperative course was uneventful for the second patient. In summary, a large, well-encapsulated cystic mass in the pancreas of a young man should raise suspicion of solid pseudopapillary tumour.

Un homme âge de 30 ans sans antecedents pathologiques notables, avait consulte pour l'apparition trois mois auparavant d'une lesion corneenne de l'œil droit. Des l'examen par la simple inspection, une lesion saillante, accrochee au limbe temporal masquait la partie temporale de la cornee. Cette image se voyait confirmee par l'examen a la lampe a fente, la lesion etait finement polylobee et avait un contour irregulier vers la cornee. Elle empietait a la fois sur la cornee et sur le versant limbique de la conjonctive (A). L'acuite visuelle etait a 10/10. Le reste de l'examen ophtalmologique etait normal. Devant cet aspect clinique evocateur d'une lesion tumorale de la surface oculaire droite, il fut propose au patient une exerese chirurgicale reglee. L'exerese fut donc realisee sous anesthesie locale sous microscope operatoire permettant une excision complete de la lesion. L'examen histologique a confirme le diagnostic de carcinome in situ (B). Les suites operatoires immediates etaient simples. Cependant, l'evolution a ete marquee par la survenue six mois plus tard, d'une recidive locale imposant une reintervention chirurgicale.

A 36 year-old female patient gravida 2 para 1, with no particular past medical history consulted her gynecologist at 14 weeks' gestation for pelvic pain. Her first pregnancy was uneventful and she did not take any specific drugs prior or during her pregnancy. Consanguinity and hereditary diseases were denied. Ultrasonography revealed a retention image measuring 67,2 mm with no cardiac pulsations (A). A male cyclopean fetus was delivered by induced labour. The fetus weighed 13,5 g and the placenta 45,4 g. On examination, the fetus was monophtalmic with completely fused eyes (B). In the face was a central proboscis located above the single orbital cavity (B). It had a rhombic form presenting with two lateral commissures and one caruncle at the inferior point of union. There was one lacrimal punctum in the midline and no median cleft. The nasal structures were absent. The upper lip looked normal with both, philtrum and tuberculum labii superioris. The lower lip and the mandible were normal. The brain and the rest of the organs were macerated. The examination of the placenta did not disclose any anomaly. Genetic analysis was not performed.

Schistosomiasis is a chronic enteropathogenic disease caused by blood flukes of the genus Schistosoma. Coexistence of schistosomiasis with Crohn's disease is very rare. To the best of our knowledge, this association has been described in literature only once. A 20-year-old male patient with a past medical history of appendectomy and ileocecal Crohn's disease, presented with abdominal pain and vomiting. Ileocolonoscopy showed an ulcerated and congested appearance of the upper rectum and sigmoid. Computed tomography scan revealed a circumferential thickening of the terminal ileum with luminal stenosis. Histopathological examination of the biopsy specimens revealed a focally ulcerated colonic epithelium. The lamina propria was fibrous harbouring a polymorphic inflammatory infiltrate including lymphocytes and plasma cells organized in lymphoid follicles admixed with eosinophils and neutrophils. In the submucosa, there were two well-preserved schistosoma eggs surrounded by a thick shell with a barely visible terminal spine. The final pathological diagnosis was colonic schistosomiasis associated with Crohn's disease. The patient underwent an ileocecal resection for stenosis of the terminal ileum complicated with enterocutaneous fistula. The postoperative course was uneventful. A stool examination and serology tests were planned for this patient who was lost to follow-up.

Splenosis is an uncommon benign condition resulting from heterotopic autotransplantation of splenic tissues onto exposed vascularised intra- and extraperitoneal surfaces following splenic trauma and surgeries. Splenosis may be mistaken for carcinomatosis upon standard imaging techniques. A 69-year-old female patient with a past medical history of hypertension and splenic trauma, underwent total esophagectomy with polar gastrectomy for adenocarcinoma of the gastric cardia. Macroscopic examination of the surgical specimen disclosed a tumour of the cardia measuring 5 cm in greatest diameter and several dark brown nodules of the greater omentum ranging in size between 2 mm and 12 mm. Histological examination of these nodules confirmed the diagnosis of peritoneal splenosis. The authors emphasize that in patients with a previous history of splenic trauma or surgery, clinicians must consider the existence of splenosis.Pan African Medical Journal 2016; 23