Search

INTRODUCTION Childhood ocular trauma is a preventable cause of visual impairment and blindness worldwide. The purpose of our study was to determine demographic, etiologic, and clinical characteristics, visual outcome, and factors affecting visual prognosis in children with open globe injuries (OGI) and to analyze the predictive value of ocular trauma scoring systems for OGI in children. METHODS We conducted a retrospective study enrolling 120 pediatric patients hospitalized for OGI from January 2010 to March 2017. Age, gender, date of trauma, time between trauma and presentation, place and circumstances of injury, etiology, visual acuity (VA), wound location and type of injury based on the Birmingham Eye Trauma Terminology, and the clinical signs were recorded. We recorded the number of surgical procedures performed, complications and visual outcomes. RESULTS The mean age was 7.38 years. In all, 62.5% of the patients were male, and 37.5% were female. The gender ratio was observed to decrease with increasing age. The mean time interval between injury and consultation was 22.80±42.68hours. Injuries usually occurred at home (80%) followed by playgrounds and sports venues (8.3%), the street (6.7%) and school (5%). All of the OGI's were accidental, and the main context was play (70%). The most common traumas were penetrating injury (60.8%) and metal (30%) objects. Penetrating trauma accounted for 68.3% of cases, followed by rupture (27.5%) and intraocular foreign body (IOFB) (7.5%). Initial VA was

Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpes virus 8 (HHV-8), causes primary effusion lymphoma, multicentric Castleman's disease, and Kaposi's sarcoma. Few antiviral drugs are available to efficiently control KSHV infection, and therefore, the development of novel, effective anti-KSHV treatments is needed. The aim of this study was to determine the antiviral activity of ethanolic and aqueous extracts, essential oils, and certain flavonoids (hesperidin, eupafolin, and vicenin) derived from Thymus capitatus (commonly known as thyme). We assessed the toxicity of these different extracts and components in RPE-1 cell cultures using the MTS test and evaluated their antiviral effect using the TCID

In the last year, the COVID-19 pandemic has highly affected the lifestyle of the world population, encouraging the scientific community towards a great effort on studying the infection molecular mechanisms. Several vaccine formulations are nowadays available and helping to reach immunity. Nevertheless, there is a growing interest towards the development of novel anti-covid drugs. In this scenario, the main protease (Mpro) represents an appealing target, being the enzyme responsible for the cleavage of polypeptides during the viral genome transcription. With the aim of sharing new insights for the design of novel Mpro inhibitors, our research group developed a machine learning approach using the support vector machine (SVM) classification. Starting from a dataset of two million commercially available compounds, the model was able to classify two hundred novel chemo-types as potentially active against the viral protease. The compounds labelled as actives by SVM were next evaluated through consensus docking studies on two PDB structures and their binding mode was compared to well-known protease inhibitors. The best five compounds selected by consensus docking were then submitted to molecular dynamics to deepen binding interactions stability. Of note, the compounds selected via SVM retrieved all the most important interactions known in the literature.

The study involved a 28-year-old female patient with no particular past medical history. At 7 weeks of amenorrhea, she presented at the Gynecological Emergency Department with pelvic pain. Clinical examination showed good general condition; vaginal examination objectified that the cervix was very far back (posterior), closed, without metrorrhagias or latero-uterine mass. Ultrasound showed fetal cardiac activity and all around the sac several “lacunae” (empty spaces) without leakage of fluid. Molar pregnancy was suspected based on image examination; hCG level was 37920 UI. The diagnosis of embryonated mole was evoked and complementary thoraco-abdominopelvic CT scan was performed to support the diagnosis and as staging evaluation. This showed partial hydatiform mole without signs of loco-regional or remote extension, with anterior intrauterine myoma. Ultrasound-guided aspiration was performed after availability of blood supply. During aspiration, vescicles were observed. Anatomo-pathological examination initially showed interrupted pregnancy with no chorionic villi. Given the strong suspicion of molar pregnancy, multiple sections were performed which showed rare large chorionic villi with edematous axis. These rare villi were lined with trophoblastic coverage of usual abundance and morphology, suggesting partial mole. The woman received effective contraception with weekly monitoring of BHCG levels. She was monitored until she experienced negative results from three consecutive tests (A, B, C, D).

Biofilms are communities of aggregated bacterial cells embedded in a self-produced extracellular polymeric matrix. Biofilms are recalcitrant to antibiotic treatment and immune defenses and are implicated in many chronic bacterial and fungal infections. In this review, we provide an overview of the contribution of biofilms to persistent infections resistant to antibiotic treatment, the impact of multispecies biofilms on drug resistance and tolerance, and recent advances in the development of antibiofilm agents. Understanding the mechanisms of antibiotic resistance and tolerance in biofilms is essential for developing new preventive and therapeutic strategies and curbing drug resistance.

The ankyloblepharon filiform adnatum (AFA) is a rare congenital palpebral abnormality characterized by a partial non disjunction of the gray lines of upper and lower eyelids. We report two cases of newborns presenting with ankyloblepharon and highlight its potentially amblyogenic impact and the possible ocular and systemic associations.

In hospitals, the use of medical instruments and products containing mercury and the management of mercury waste (MW) collected are regulated in developed countries. In Tunisia, MW end up in landfill and no strategy has so far been adopted. The objective of this study was to quantify MW in two university hospitals in Tunis and to indicate the elimination pathways used and to propose certain recommendations.This was a descriptive retrospective study conducted from February to August 2016 and quantifying the MWs from medical products and instruments used by two university hospitals in Tunis during 2015. Semi-structured interviews and focus groups enabled the collection of informations on MW management methods for these products and instruments and their waste and to identify the weaknesses of this management.In 2015, 2,443 mercury thermometers were used by Habib Thameur hospital (HHT) and 7,439 by La Rabta hospital (HLR), releasing 19,764 g of mercury. For dental amalgams, 1,440 g were used at HHT. Their residues (320.4 g) were stored in the original capsules. At HLR, 1,320 g were used but residues, estimated at one-third of the total amount (440g), were discharged into the cuspidor. The total amount released from the amalgams was 380.2g, knowing that half of the volume was mercury. The broken tensiometers (26 at HHT and 113 at HLR) released 183.5g of mercury, the roasted fluorescent lamps (1,627 at HHT and 1,722 at the HLR) 167.4g, Harris Hematoxylin (15 liters at HHT and 18 liters at HLR) 82.5g and used batteries (1,258 at the HHT and 914 at the HLR) 54,3g. In total, with the exception of mercury vapors, the amount of mercury released in 2015 at the two hospitals was approximately 20,632 g. These MW have borrowed the household waste stream (51% of HHT MW and 47% of HLR MW), waste from infectious care activities (47% HHT and 46% of the HLR MW), electrical and electronic waste (1% of HHT and HLR MW), and sewage (1% of HHT MW and 6% of the HLR MW).The main supplier of hospital MW is the mercury thermometer (95.8%). The managerial authorities would benefit from the promulgation of a regulatory framework, like the European law of 1998, prohibiting their use on a territorial scale and, by subsidies, replace them with electronic thermometers.

International audience; Chemical decomposition and fragmentation may limit the detection of ancient host and microbial DNA while some proteins can be detected for extended periods of time. We applied paleoproteomics on 300-year-old dental pulp specimens recovered from 16 individuals in two archeological funeral sites in France, comprising one documented plague site and one documented plague-negative site. The dental pulp paleoproteome of the 16 teeth comprised 439 peptides representative of 30 proteins of human origin and 211 peptides representative of 27 proteins of non-human origin. Human proteins consisted of conjunctive tissue and blood proteins including IgA immunoglobulins. Four peptides were indicative of three presumable Yersinia pestis proteins detected in 3/8 dental pulp specimens from the plague-positive site but not in the eight dental pulp specimens collected in the plague-negative site. Paleoproteomics applied to the dental pulp is a new and innovative approach to screen ancient individuals for the detection of blood-borne pathogens and host inflammatory response.

Effective donor skin disinfection is essential in preventing bacterial contamination of blood components with skin flora bacteria like Staphylococcus epidermidis. Cell aggregates of S. epidermidis (biofilms) are found on the skin and are resistant to the commonly used donor skin disinfectants chlorhexidine-gluconate and isopropyl alcohol. It has been demonstrated that essential oils synergistically enhance the antibacterial activity of chlorhexidine-gluconate. The objective of this study was to test plant-extracted essential oils in combination with chlorhexidine-gluconate or chlorhexidine-gluconate plus isopropyl alcohol for their ability to eliminate S. epidermidis biofilms.The composition of oils extracted from Artemisia herba-alba, Lavandula multifida, Origanum marjoram, Rosmarinus officinalis, and Thymus capitatus was analyzed using gas chromatography-mass spectrometry. A rabbit model was used to assess skin irritation caused by the oils. In addition, the anti-biofilm activity of the oils used alone or in combination with chlorhexidine-gluconate or chlorhexidine-gluconate plus isopropyl alcohol was tested against S. epidermidis biofilms.Essential oil concentrations 10%, 20%, and 30% were chosen for anti-biofilm assays, because skin irritation was observed at concentrations greater than 30%. All oils except for O. marjoram had anti-biofilm activity at these three concentrations. L. multifida synergistically enhanced the anti-biofilm activity of chlorhexidine-gluconate and resulted in the highest anti-biofilm activity observed when combined with chlorhexidine-gluconate plus isopropyl alcohol. Gas chromatography-mass spectrometry revealed that the main component contributing to the activity of L. multifida oil was a natural terpene alcohol called linalool.The anti-biofilm activity of chlorhexidine-gluconate plus isopropyl alcohol can be greatly enhanced by L. multifida oil or linalool. Therefore, these components could potentially be used to improve blood donor skin disinfection.

NLRP3 (NOD-like receptor family, pyrin domain-containing protein 3) activation has been linked to several chronic pathologies, including atherosclerosis, type-II diabetes, fibrosis, rheumatoid arthritis, and Alzheimer’s disease. Therefore, NLRP3 represents an appealing target for the development of innovative therapeutic approaches. A few companies are currently working on the discovery of selective modulators of NLRP3 inflammasome. Unfortunately, limited structural data are available for this target. To date, MCC950 represents one of the most promising noncovalent NLRP3 inhibitors. Recently, a possible region for the binding of MCC950 to the NLRP3 protein was described but no details were disclosed regarding the key interactions. In this communication, we present an in silico multiple approach as an insight useful for the design of novel NLRP3 inhibitors. In detail, combining different computational techniques, we propose consensus-retrieved protein residues that seem to be essential for the binding process and for the stabilization of the protein–ligand complex.

Le léiomyome de la vessie est une tumeur bénigne rare réputée avoir un bon pronostic après traitement chirurgical. Ceci n’est malheureusement pas toujours vrai. Nous rapportons le cas d’une patiente âgée de 33 ans qui a consulté pour des douleurs lombaires droites. Les explorations réalisées ont conclu à une tumeur solide du plancher vésical avec, en amont, un rein droit non fonctionnel et des voies urinaires gauches dilatées. La cystoscopie a objectivé une tumeur solide de la vessie périméatique droite. Des biopsies tumorales ont été faites en même temps qu’une montée de sonde double J gauche. L’étude anatomopathologique a conclu à un léiomyome vésical. Elle a eu une myomectomie par voie transvésicale. Les suites opératoires étaient simples. La patiente a toutefois gardé comme séquelle un rein totalement détruit.Pan African Medical Journal 2016; 24

Staphylococcus epidermidis is a leading cause of hospital-acquired infections, mostly associated with the use of medical devices in immunocompromised patients. It originates from the patient's own skin flora, which is subject to severe changes as a result of selective pressure exerted by the hospital environment. This notion led us to compare S. epidermidis isolates from catheter related infections (CRI), non-catheter related bacteremia (NCRB) and catheter hub cultures (commensal isolates). The collection comprised 47 CRI strains from the Bone Marrow Transplant Centre of Tunis, 25 NCRB strains and 25 commensal isolates from patients hospitalized in the same center. Antimicrobial resistance and virulence-associated genes (icaABC, aap, atlE, bhp, fbe, embp, and IS256), polysaccharide intercellular adhesin synthesis, and biofilm formation were investigated. The clonal relationship of strains was investigated by pulsed field gel electrophoresis. Whereas bhp, atlE, fbe, embp, and aap were almost ubiquitously amplified, resistance to oxacillin, kanamycin, tobramycin, gentamicin, cotrimoxazole, and fosfomycin, biofilm production, ica genes, and IS256 were significantly more frequent in invasive (CRI and NCRB strains) than in commensal strains. Moreover, strong biofilm production was significantly more frequent among CRI strains than in NCRB strains. In conclusion, when S. epidermidis is isolated from blood cultures, the detection of strong biofilm production may be significant with regard to judging whether the detected strain is an etiologic agent of CRI.

Summary Aims Solitary fibrous tumours (SFT) of the central nervous system are rare neoplasms that usually present as durabased masses and clinically resemble meningiomas. Histologically, they can be similar to haemangiopericytoma or fibrous meningioma. We present herewith a pathological study of eight patients with SFT and compare our results with the published data. Methods All tumours diagnosed as SFT over a period of 15 years were retrieved from the files of La Rabta Hospital Department of Pathology, Tunisia. Routine histological sections were prepared from formalinfixed, paraffinembedded specimens. Immunohistochemical analysis was performed using antibodies raised against vimentin, CD34, CD99, Bcl2 and MIB1. Results The SFT group consisted of four males and four females with a mean age of 44 years. The tumours were supratentorial in six cases, tentorial in one case and located in the lateral right ventricle in the last case. All patients underwent surgery as initial treatment. Histologically, SFT were similar to their soft tissue counterparts. Two cases demonstrated increased cellularity, marked nuclear hyperchromasia and marked cellular pleomorphism. Only the later two cases recurred after 6 months of followup. Conclusion Little is known about the biological behaviour of SFT, although most seem amenable to total resection.

Peritoneal tuberculosis and carcinomatosis are the most frequent etiologies of exsudative ascitis and require rapid diagnosis and treatment. The purpose of this study has been to evaluate the predictive value of clinical and complementary data for the etiologic diagnosis of exsudative ascites and to assess the results of laparoscopic surgery.We report a prospective long-term study conducted over 10 years, having included all cases of exsudative ascites of unidentified etiology. We excluded patients with a history of anterior laparotomy and patients having a contraindication for laparoscopic surgery. Clinical signs, results of the cytochemical and bacteriological exam of the ascetic liquid and findings from radiological exams and endoscopic investigations were noted. Open laparoscopic exploration noted the macroscopic aspect and many peritoneal biopsies were obtained as well as a liver biopsy when possible. Statistical analysis was performed with SPSS10.0 software. The degree of statistical significance was set for P0.05.We included 90 cases of isolated exsudative ascites. There were 59 cases of tuberculosis and 31 of carcinomatosis. Mean patient age was 47 years with a sex ratio of 0.5. Bowel transit disorders were significantly in favor of a carcinomatosis (P=0.04) while fever and nocturnal sweats were suggestive of tuberculosis (P=0.04) but in both instances, the positive predictive value (PPV) of these two signs was weak, respectively 29% and 43%. Relative to chemical and cytologic study of ascitic fluid, hemorrhagic fluid, low white cell count, low lymphocyte differential and presence of atypical cells were significantly linked with the carcinomatosis (P=0.01) but with a PPV85%. Radiological exams were not very contributive for the etiologic diagnosis. The laparoscopic peritoneal aspect was typical of tuberculosis in 90% of proved cases and in 29% of carcinomatosis cases, underlying the importance of peritoneal biopsies for histological study. Hepatic tuberculosis was associated with peritoneal localisation in 48% of cases. We had no surgical mortality and the morbidity was about 1%.Etiological diagnosis of exsudative ascitis remains difficult to establish. Peritoneal biopsies under videolaparoscopy are currently the "gold standard" for diagnosis.

Layouts of biomedical devices were tightly related with the emergence of Staphylococcus epidermidis as a major cause of nosocomial infections because of its ability to form biofilm on the biomaterial surfaces. This fact led researchers to develop in-vitro models to simulate what is really happening during biofilm formation process in order to have a better understanding of this phenomena and then to control it and to resolve the associated problems. The aim of this paper was to develop a homemade dynamic device based on instruments used in clinical practice, easy to mount, with low coast and with no sophisticated features.used to evaluate this dispositive were hydrodynamic calculation and enumeration of bacterial cells on petri dishes and with real time polymerase chain reaction during simulation of Staphylococcus epidermidis biofilm eradication with daptomycin.With hydrodynamic calculation, Reynolds number was estimated to be 26.62 corresponding to a perfect laminar flux giving suitable dynamic growth environment for such experiment. Data recovered from cell enumeration with the two methods showed that bacterial colonization of the tested catheter segment was significantly reduced after 24 and 48h of treatment with daptomycin (P0.01) reflecting a considerable reliability of this device.the simple dispositive developed in this work has shown acceptable hydrodynamic proprieties and good reliability making research on biofilm easy to reach.

A case of intraprostatic cyst is reported. The patient presented with a completely evacuated hydatid cyst of the prostate. The intraprostatic cystic cavity that was communicating with the urethra developed urinary stones. The patient had transurethral resection of the prostate, the stones in the cyst were pushed into the bladder and fragmented using a ballistic lithotripter. Pathological examination concluded to a prostatic hydatid cyst that had evacuated through the urethra and was complicated by stone formation within the residual cavity. Postoperative course was uneventful and follow-up did not show evidence of recurrence. This is the first case of hydatid cyst of the prostate to present as an intraprostatic stone pouch.

Primary fallopian tube carcinoma are extremely rare and are most commonly of serous or endometrioid type. Primary squamous cell carcinomas are exceptional with only three cases reported in the English literature.We present the case of a 43-year-old woman operated for cervical carcinoma.Histologic examination, showed a squamous cell carcinoma of cervix with post operative discovery of a concomitant microinvasive squamous carcinoma of fallopian tube developing on high grade dysplasia and in situ carcinoma lesions.Clinico-pathological features of fallopian tube carcinoma, in general, and squamous carcinoma, in particular, will be discussed.

Polymerase chain reaction (PCR) amplification of antibiotic resistance genes as well as staphylococcal cassette chromosome mec (SCCmec) typing and pulsed-field gel electrophoresis (PFGE) of SmaI macrorestriction fragments of genomic DNA were used to characterize 45 methicillin-resistant coagulase-negative staphylococci (MRCoNS) isolates responsible of bacteremia recovered in patients at the Bone Marrow Transplant Centre of Tunisia in 1998–2007. Among the 45 MRCoNS isolates, Staphylococcus epidermidis was the most prevalent species (75.6%) followed by Staphylococcus haemolyticus (22.2%) and Staphylococcus hominis (2.2%). Extended susceptibility profiles were generated for MRCoNS against 16 antimicrobial agents. Out of 45 mecA-positive strains, 43 (95.6%) were phenotypically methicillin-resistant and two (4.4%) were methicillin-susceptible. The msr(A) was the most prevalent gene (13 isolates; 48.1%) among erythromycin-resistant isolates. The erm(C) was found alone in seven (25.9%) or in combination with both erm(A) and erm(B) in two (7.4%) isolates. The aac(6′)-Ie-aph(2″)-Ia was the most prevalent gene among aminoglycoside-resistant isolates, detected alone in 14 isolates (33.3%) isolates, in combination with ant(4′)-Ia in 18 (42.8%) isolates, in combination with aph(3′)-IIIa in four (9.5%) or with both ant(4′)-Ia and aph(3′)-IIIa in two (4.7%) isolates. The ant(4′)-Ia was detected in three (7.1%) isolates and the aph(3′)-IIIa in one (2.4%) isolate. Among tetracycline-resistant isolates, six (85.7%) strains harbored the tet(K) gene and one (14.3%) strain carried tet(K) and tet(M) genes. SCCmec types IV (31%) and III (24.5%), the most prevalent types detected, were found to be more resistant to non-β-lactam antibiotics. A wide diversity of isolates was observed by PFGE among MRCoNS.

The aims of our study were to determine the frequency of granulomatous hepatitis in patients with peritoneal tuberculosis, to identify factors for high risk and whether it is associated with higher frequency of antituberculous treatment side effects.We carried out a prospective study on patients with histologically proven peritoneal tuberculosis between January 1996 and December 2005. We performed a liver biopsy in all the patients before starting the antituberculous treatment. Granulomatous hepatitis was systematically searched in all patients.The study was conducted in 52 patients, 9 men and 43 women of median age of 35,5 years. A granulomatous hepatitis was seen in 24 patients (46%). In univariate analysis the factors associated with a high risk of liver involvement were a higher level of gamma-glutamyl transpeptidase (44.5 + 36.8 IU/l vs 23.3 + 9.28 IU/l p = 0.005), a higher level of phosphatases alkalines (233.9 + 96.6 IU/l vs 189.4 + 49.9 IU/l p = 0.03) and a lower level of cholesterol (1.22 + 0.2 g/l vs 156 + 0.3 g/l p0.0001). In multivariate analysis, only a cholesterol level lower than 1,31 g/l was significantly associated with a granulomatous hepatitis (p = 0.006 OR [IC 95%]: 0.10 [0.02-052]).We have found a frequent liver involvement in the case of peritoneal tuberculosis (46%). Cholesterol level lower than 1,31 gr/l was an independent predictor of granulomatous hepatitis in patients with peritoneal tuberculosis. We suggest, in this case, that percutaneous liver biopsy can be considered as an alternative to laparoscopy.

Extraventricular neurocytomas are rare neuronal tumours that have been included in the 2007 WHO classification as a variant of central neurocytoma. They arise outside the ventricles, usually within the cerebral hemisphere,s but also in other regions throughout the neuraxis. The morphological overlap of these tumours with oligodendroglioma often poses diagnostic difficulty. Herein, a case of extraventricular neurocytoma in a 4-year-old girl is reported that mimicked histologically oligodendroglioma. The authors describe the clinicopathological features of this rare entity with special emphasis on differential diagnosis.

Intracranial germ cell tumors are rarely seen and typically localize in the pineal or suprasellar region. The largest category of germ cell tumors is dysgerminoma.to describe clinicopathological features and immunohistochemical profile of dysgerminomas.We report three cases of central nervous system dysgerminomas. There were two young women and a man who were 6, 11 and 23-year-old. They presented with symptoms of insipidus diabetes (n=3) with association to visual field defects in the third case. Radiological findings showed a supra seller lesion in two cases. Double localization in the pineal and suprasellar regions was seen in the third case. Histologic examination and immunohistochemical study of surgical specimen were consistent with primary central nervous system dysgerminoma.

Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body.The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature.A retrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken.There were 101 male and 164 female patients (sex ratio M/F = 0.61) ranging in age from 2 to 84 years (mean age = 38.7). In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%). The other less frequent sites included the peritoneum (n = 9), heart (n = 9), bone (n = 6), adrenal gland (n = 4), epiploon (n = 4), orbit (n = 4), ovary (n = 3), prostate (n = 2), bladder (n = 2), breast (n = 2), Douglas' cul-de-sac (n = 2), diaphragm (n = 1), testis (n = 1), broad ligament (n = 1), mediastinum (n = 1), nasal cavity (n = 1), soft tissue (n = 1), abdominal wall (n = 1), parotid gland (n = 1), psoas muscle (n = 1), synovia (n = 1), thymus (n = 1) et le pancreas (n = 1).In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank.

Angiomyofibroblastoma is a rare, benign, mesenchymal tumour occurring mainly in the female genital tract, and more rarely, in males. We present a new case of angiomyofibroblastoma arising in the left inguinal region of an 83-year-old man. The tumour was well circumscribed and measured 60 mm in maximum dimension. On microscopic examination, the tumour was composed of small spindle cells without atypia within a fibrous and myxoid stroma where scattered mononuclear inflammatory cells were found around the capillaries of the stroma. Immunohistochemical studies showed positive staining of tumour cells for vimentin, desmin, smooth muscle actin and CD34, and negative staining for PS100 and oestrogen and progesterone receptors. These histological findings are consistent with angiomyofibroblastoma. The patient was followed up for 4 years without recurrence.

Infantile desmoplastic fibromatoses are benign fibrous tissue tumours, non-metastasizing but locally aggressive and with high likelihood of recurrence. Many cases occur in young children between 18 months and 3 years and commonly present as painless mass of the submandibular region. The maxilla is rarely involved.Through this report and a review of literature, we are going to study clinical, pathological and prognostic characteristics of this affection.We report here a case of an aggressive desmoplastic fibroma arising in a 20-months-old infant originating in the left anterior maxillary wall. Clinical examination of the face revealed a non tender, firm, expansion of the left maxilla of 2.5 cm of diameter. The diagnosis of DF of the maxilla was made on the basis of histological features on biopsy specimen. No other location of the fibromatosis was found. The child had a favourable course.DF is an intraosseous, non metastasizing and locally aggressive fibrous tumour. Although its benignity, it could engage vital prognosis since it can extend into vital organs.

Objective To analyze epidemiological characteristics, clinical symptoms, radiological aspects, treatment and outcome of central nervous system hydatidosis and compare our results with those reported in literature. Patients and methods In our retrospective study, we reviewed 39 cases of primary central nervous system hydatid cysts operated on in our hospital between 1998 and 2007. Results There were 20 male and 19 female patients (sex-ratio M/F = 1.05) between 2 and 68 years of age (mean = 26.5 years). Thirteen of the patients were children (33.3%) with a mean age of 6.8 years and 26 were adults (66.7%) with a mean age of 36.3 years. The location of hydatid cysts was intracranial in 27 cases (69.2%) and spinal in 12 cases (30.8%). Headache and motor deficits were the predominant symptoms in patients with intracranial hydatidosis whereas back pain and spinal cord compression syndrome were the most frequent clinical presentations in patients with spinal hydatidosis. All patients underwent surgical resection of the cyst. Pathologic findings were consistent with hydatid cyst in all cases. During the follow-up period which ranged between 12 months and 5 years, 12 patients had recurrence (30.7%). Only one patient with intracranial hydatid cyst died postoperatively due to anaphylactic shock. Conclusion Despite all the advances in imaging techniques and therapeutic methods, central nervous system hydatidosis remains difficult to cure and patient outcomes are not satisfactory especially in case of spinal involvement due to the high incidence of recurrence.

Carcinosarcoma of the urinary bladder is a very rare neoplasm accounting for less than 0,05% of urothelial tumours is a biphasic malignant neoplasm with only 79 cases reported in the English literature. Histologically, it exhibits morphologic and/or immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. It usually involves aged adults after 60 years and it has a poor prognosis.We report three cases with an emphasis on unusual histologic features.Three male patients age 76 to 86 years were found to have polypoid masses in the urinary bladder. In all cases, microscopic examination revealed biphasic neoplasms with distinct mesenchymal and epithelial components. The two first cases were remarkable respectively by the presence of chondrosarcomatous and osteosarcomatous components.

The authors wanted to analyze the epidemiological features of extrapulmonary hydatid cysts and compare their results with those reported in literature.Two hundred and sixty-five cases of extrapulmonary hydatid cysts collected from 1990 to 2007 were retrospectively studied.One hundred and one male and 164 female patients (sex ratio M/F=0.61 mean age 38.7 years) were included. In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%).Contrary to published data, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which ranks 3rd. Such unusual results may be due to a selection bias.

Cutaneous gamma-delta T-cell lymphoma (CGD-TCL) is an uncommon lymphoma composed of a clonal proliferation of mature activated gamma-delta T-cells expressing a cytotoxic phenotype. Malignant lymphoma is rarely associated with Behcet's disease, as only 12 cases have been reported in the literature, including a case of cutaneous T-cell lymphoma. In this report, the authors present a new case of CGD-TCL emerging in the course of Behcet's disease in a 40-year-old man. Diagnosis of CGD-TCL was established based on the combination of clinical, histological, immunophenotypical and molecular findings. Through a review of the current literature, the authors analyse the unique clinicopathological, molecular and immunohistochemical features of this rare cutaneous lymphoma.

Most mesenchymal tumours of the gastrointestinal tract are now referred to as gastrointestinal stromal tumours (GISTs). These tumours typically express c-kit (CD117) and CD34; 30-50% are (often focally) positive for alpha-smooth muscle actin, and all are negative for desmin and S100 protein. Recently, mutations in exon 11 of the c-kit gene have been identified as a molecular genetic marker for the subset of GISTs. In this report, we describe a mesenchymal tumour removed from the pelvic cavity of a 34-year-old man. The tumour was strongly attached to the external wall of the urinary bladder. The neoplasm grossly resembled a leiomyoma, and was histologically composed of sheets of spindle cells with a dense collagenous background. The mitotic activity was low (less then 1 per 50 high-power fields). Immunohistochemically, tumour cells were negative for alpha-smooth muscle actin and desmin and positive for CD117 and CD34. This case illustrates that tumours which are phenotypically and genotypically similar to GISTs may present in sites other than the tubular gastrointestinal tract.

Renal epithelioid angiomyolipoma is a recently recognized variant of angiomyolipoma, closely simulating renal cell carcinoma both clinically and histologically. Only a relatively small number of cases of epithelioid angiomyolipoma of the kidney have been reported.To highlight clinicopathological features of this rare tumour.We report herein a new case of renal epithelioid angiomyolipoma in a 38-year-old male with no stigmata of tuberous sclerosis. The tumour was composed of diffuse sheets of epithelioid cells, small numbers of adipocytes and occasional blood vessels. Immunohistochemically, neoplastic cells were immunoreactive for HMB-45, but negative for cytokeratin. The patient showed no evidence of recurrence or metastatic disease one year after radical nephrectomy.Epithelioid angiomyolipoma may be locally aggressive and can metastasise; therefore, long-term post-operative follow-up is mandatory.

Primary cutaneous leiomyosarcoma is an uncommon malignant neoplasm with a predilection for the lower extremities. A retrospective study of 4 cases was undertaken to analyse the clinicopathological characteristics and immunohistochemical profile of these neoplasms with emphasis on prognosis. Two male and 2 female patients aged between 49 and 80 years presented with painless tumours involving the lower lip, the chin, the scrotum and the shoulder. Histological examination of the initial biopsy specimen established a diagnosis of cutaneous leiomyosarcoma. All cases co-expressed smooth muscle actin and vimentin regardless of primary tumour site. Wide surgical excision of the tumour was performed in only 3 cases, and the remaining patient refused further treatment. Of the patients undergoing surgical intervention, local recurrence occurred in one case. No metastases were observed. Long-term follow-up of patients with cutaneous leiomyosarcoma is mandatory to detect local recurrence and distant metastases that can occur even years after the initial excision.

Extramedullary plasmocytoma is rare, with less than 50 reported cases and only 8 cases of primary testicular plasmocytoma.Report of a new caseThis report concerns a 65-year-old patient presenting an enlargement of the testis. The diagnosis of testicular plasmocytoma was made on histological examination. There was no evidence of bone marrow involvement or systemic signs of myeloma. This case will be studied with a review of the literature.

Central nervous system tumours represent 20% of all childhood cancers, and are the second most common group of neoplasms after leukaemias.To describe epidemiological characteristics of central nervous system tumours in a paediatric Tunisian population.A retrospective study of 492 childhood central nervous system tumours operated between 1990 and 2004 was undertaken. We investigated the age-related location, gender distribution and the histology of all tumours, and adopted the latest WHO classification (2007) in grouping all the tumours.There were 488 primary and 4 secondary tumours; 426 (86.6%) were intracranial and 66 (13.4%) were intraspinal. Of the 426 intracranial tumours, 214 (50.24%) were supratentorial and 212 (49.76%) were infratentorial. The median age at diagnosis was 8 years, with a male:female ratio of 1.14:1. Low-grade tumours (WHO I/II) constituted 67.3% of all lesions and the rest (32.7%) were high-grade tumours (WHO III/IV). The most common tumour found in our series was astrocytoma (38%), followed by medulloblastoma (16.2%), then ependymoma (6.9%), cystic tumours (6.3%) and craniopharyngioma (5.3%). The overall 5-year survival rate was 45% with a mean follow-up period of 36 months.In our patient population, the incidence and distribution of central nervous system tumours were similar to those reported in literature. Overall survival rates varied according to tumour location and histopathology.

Primary melanocytic neoplasms of the central nervous system consist of a spectrum of lesions ranging from well-differentiated melanocytoma to its overtly malignant counterpart, melanoma. Clinicopathologic features of 5 cases of primary central nervous system malignant melanoma were studied to define histologic appearances, diagnostic criteria, and the clinical behavior of lesions along this spectrum. There were three women and two men (mean age was 35 years) with symptoms of increased intracranial pressure. Radiological findings showed a solitary intra parenchymal lesion with variable enhancement after gadolinium administration. All patients underwent surgical treatment. Histologic examination revealed primary melanoma.

Canalicular adenoma is a benign tumor which comprises 1% of salivary gland neoplasms and 4% of minor salivary gland tumors. It occurs in the upper lip mucosa in about 90% of cases. The next most common location is the buccal mucosa (9.5% of tumors). We present herein a new case of canalicular adenoma of buccal mucosa involving a 74-year-old man. He was suffering of a slowly growing and painless nodule of the right buccal mucosa. The treatment was surgery and histological findings were consistent with the diagnosis of canalicular adenoma. No recurrence was noted one year later.

To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations.This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations.In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%).In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low sensitivity of 67%. Our results demonstrate the reliability of intraoperative frozen-section analysis in thyroid surgery. Collaboration between pathologists, radiologists, and clinicians should be emphasized.

Seborrheic keratosis are one of the most common benign epidermal tumors encountered in clinical practice. Malignant transformation is exceptional. It may occur by the involvement of human papilloma virus. We report two cases of seborrheic keratosis in respectively 58 and 60-years-old women, which, on biopsy, revealed the presence of Bowen's disease for the former and Squamous cell carcinoma for the later.

Primary subcutaneous cyst hydatid disease is an exceptional entity. We report a new case involving a 70-year-old woman hospitalized for a subcutaneous mass in the hypogastric area with no local inflammatory signs. Radiological examination was consistent with a partially calcified subcutaneous cyst in the hypogastric area. Complete surgical resection of the mass was performed with uneventful postoperative recovery. Histopathological examination of the surgical specimen demonstrated multivesicular hydatid cyst.