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Mycetoma, commonly known as Madura foot, is a chronic granulomatous infection caused either by fungi (eumycetoma) known as actinomycete. This disease occurs preferentially in young adults, and it affects the foot in particular. We report a Tunisian case of mycetoma occurring in an old patient, particular by its cystic presentation.

Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers. Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement. The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions., Highlights • Isolated pancreatic tuberculosis is an extremely rare disease, with non-specific clinical characteristics. • Clinical presentation and radiological findings of a pancreatic mass may be suggestive of malignancy. • Preoperative microbiological or/and histological diagnosis should be made to avoid the patient unnecessary surgical procedures.

Introduction and importance Histiocytic sarcoma (HS) is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. It is characterized typically by extranodal presentation and a poor clinical course, particularly in cases with disseminated disease. Case presentation This report documents a case of bifocal and aggressive HS in small bowel and lung revealed by acute peritonitis in a 63-year-old man. Clinical discussion Despite its rarity, we believe that the correct diagnosis of HS is crucial for clinical treatment and prognostic prediction. Conclusion The collection of additional cases of HS are important to obtain further progress in prognosis and guide treatment decisions., Highlights • Histiocytic sarcoma is a rare malignant neoplasm showing morphologic and immunohistochemical features of histiocytes. • The diagnosis of histiocytic sarcoma can be extremely challenging because histologic overlap with diverse mimics. • Judicious application of immunohistochemical markers is crucial to confirm the diagnosis. • The collection and evaluation of additional cases are pivotal to obtain further progress in prognosis and guide treatment decisions.

Introduction Retroperitoneal cystic immature teratoma (RCIT) is a rare disease. Its diagnosis and management are challenging. Although, the prognosis is relatively favorable, the post-operative morbidity is not rare. We hereby report a case of RCIT in an infant and describe the difficulties in diagnosis and pre-, per- and postoperative treatment. Case presentation Our patient was a 50-day-old female born at 35 weeks of gestation without prenatal diagnosis. She was admitted for abdominal distension noticed a few days earlier. Physical examination revealed a large abdominal mass located between the right hypochondrium and the left flank. Computerized tomography showed a 10*12*11 cm heterogeneous retroperitoneal mass with fat components and calcification responsible for the compression of the right kidney. Due to the respiratory distress caused by the tumor, we decided to operate the patient urgently prior to the anatomopathological examination result. The surgical procedure consisted in a large resection of the tumor which necessitated the removal of the right kidney. Postoperatively, our patient developed chylous ascites which was managed with total parenteral nutrition and continuous intravenous infusion of Octreotide. The follow up was uneventful with no recurrence so far. Conclusion RCIT is a clinically rare disease. The mainstay treatment remains the complete surgical resection of the tumor which could be a complicated procedure. Chylous ascites constitute a rare postoperative complication which can be managed safely by parenteral nutrition and continuous intravenous infusion of Octreotide.

Chronic calcific constrictive pericarditis is a rare condition. It can cause severe morbidity and even mortality. The diagnosis may be difficult to establish due to its variable clinical signs. We report an autopsy case of a 54-year-old male with a past medical history of well treated hypertension, diabetes and dyspnea present of 2 weeks, who was discovered dead in his bed. The postmortem examination showed a large band of calcification of the pericardium with obliteration of the pericardial space. Both pericardium and epicardium were thickened with bread-and-butter appearance. Microscopic examination showed thickened pericadium which is formed by a fibrous paucicellular tissue containing extensive basophilic calcifications.

Highlights • Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components. • To the best of our knowledge only eight cases have been reported in the English literature till date. • Surgical excision remains the mainstay of treatment., Introduction Gastroblastoma is a rare gastric biphasic tumor with both epithelial and mesenchymal components. To the best of our knowledge only eight cases have been reported in the English literature till date. Presentation of case We report a case of a 29-year-old female, hospitalized for epigastric pain with poor general condition. An upper gastrointestinal endoscopy showed a polypoid mass in the stomach near the gastric cardia suspicious of gastrointestinal stromal tumor. The patient underwent atypical proximal gastrectomy with splenectomy. Detailed histopathological examination of the resected specimen revealed the diagnosis of gastroblastoma. After six months, the patient developed loco-regional recurrence for which surgical debulking was performed. Discussion Gastroblastoma is predominantly seen in young adults with non-specific complaints. They appear as submucosal lesion in the stomach mimicking gastrointestinal stromal tumor. Preoperative diagnosis is often difficult. Surgical resection remains the mainstay of treatment. On histology, they consist of mesenchymal component which stain positively for vimentin and CD10 and epithelial component which is positive for cytokeratin on immunohistochemistry. Conclusion Gastroblastoma is a malignant tumor with risk of local recurrence after curative resection.

Meningeal melanocytoma is a rare benign pigmented tumor. It develops from melanocytes normally present in the meninges of the posterior fossa and medulla. It is an extra-axial tumor that manifests because of compression of adjacent structures. Although classified as a benign tumor, it can cause sudden death by several mechanisms. We report a rare case of meningeal melanocytoma and discuss the mechanism of death. A 21-year-old man with a previous history of recurrent lipothymia was admitted to the emergency department because of generalized seizures. Death occurred despite resuscitation. A medico-legal autopsy was performed. External examination of the body showed nonspecific asphyxia signs without any violence evidence. Necropsy noticed a brain edema with a dark color of the meninges especially in the frontal part. Histological examination concluded to diffuse meningeal melanocytoma with cerebral edema.

Resume Introduction Le syndrome d’insensibilite complete aux androgenes est une entite rare. Il est du a une mutation au niveau du recepteur peripherique des androgenes. Nous decrivons une nouvelle mutation au niveau de l’exon 1. Materiels et methodes Nous rapportons l’observation d’une jeune fille de 29 ans ayant un syndrome d’insensibilite aux androgenes decouvert a l’occasion de l’exploration d’une amenorrhee primaire. L’enquete familiale a revele l’atteinte de deux autres cas. Resultats Le diagnostic etait oriente par la clinique et la biologie, et confirme par la biologie moleculaire qui a mis en evidence une nouvelle mutation du gene du recepteur aux androgenes, a type de deletion au niveau de l’exon 1, non decrite auparavant. Conclusion La description d’une nouvelle mutation au niveau du recepteur aux androgenes, permet de mieux comprendre la complexite de cette pathologie. A travers ces observations, des particularites cliniques, biologiques et anatomopathologiques sont decrites.

Summary Introduction Parathyroid carcinoma (PTC) is a rare parathyroid tumor. We report a case of PTC revealed by erythema nodosum (EN). Case study A 53-year-old woman was admitted for EN exploration. Biology found hypercalcemia (3 mmol/L) and 184.89 ng/L parathormonemia. Histology following cervicotomy diagnosed PTC. Postoperative course was free of complications. At eight months’ follow-up, there was no recurrence of EN. Discussion/conclusion PCT is rare and life threatening. Paraneoplastic EN is rare, and has not previously been reported in association with PCT. Solid neoplasia and hemopathy should be systematically explored for in case of recurrent EN or resistance to conventional treatment.

Merkel cell carcinoma (MCC) or primary neuroendocrine carcinoma of the skin is a rare neoplasm with aggressive behavior. Primary lymphoepithelioma-like (LEL) carcinoma of the skin is a recently described exceptional tumor, with a relatively good prognosis, and is characterized by a neoplastic epithelial component associated with a dense lymphoid stroma. Rarely, MCC shows a marked lymphocytic host response or can even mimic a LEL carcinoma. We report a new case of MCC mimicking an LEL carcinoma in a 72-year-old male; the diagnosis of MCC was made on the basis of the morphology and immunohistochemical findings. We present through this case an exceptional pattern of MCC which can be misleading, and we insist on differential diagnoses.

Summary Introduction Secondary amyloidosis is a serious complication of rheumatoid arthritis (RA). Symptoms are late to occur, so that screening is in order, most notably in patients with long-standing RA. The objectives of our study were to determine the prevalence of subclinical amyloidosis in RA patients by abdominal fat aspiration biopsy (AFAB) and minor salivary gland biopsy (MSGB) and to identify factors associated with subclinical amyloidosis. Methods We prospectively studied 107 consecutive patients with RA (94 women and 13 men) recruited between March 2005 and January 2006. Clinical and laboratory findings, imaging study results, and treatment were recorded for each patient. AFAB and MSGB were performed routinely. Amyloid deposits were identified by polarized light microscopy after Congo red staining. Results The prevalence of subclinical amyloidosis was 21.5% by AFAB and 3.7% by MSGB. Factors associated with subclinical amyloidosis were a longer time to diagnosis ( P = 0.03), extraarticular manifestations ( P = 0.019), proteinuria >0.3 g/24 h ( P = 0.024), and absence of methotrexate therapy ( P = 0.046). Subclinical amyloidosis was not associated with age, sex, RA duration, joint deformities, DAS28 score, Health Assessment Questionnaire score, Steinbrocker radiological stage, rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein, creatinine, or hemoglobin. Conclusion The prevalence of subclinical amyloidosis by AFAB is high (21.5%). AFAB is more sensitive than MSGB for detecting subclinical amyloidosis. A simple screening tool such as AFAB should be used, particularly in patients with risk factors. Subclinical amyloidosis requires close monitoring to ensure the early detection and treatment of symptomatic amyloidosis.

By far the highest incidence of the Epstein-Barr virus (EBV)-associated nasopharyngeal carcinomas in young subjects was found in North Africa, a region of intermediate risk for adults. We used the immunofluorescence analysis and ELISA to characterize the presence of IgG autoantibodies to the cytoskeleton and nuclear proteins in sera of 82 Tunisian patients with primary nasopharyngeal carcinoma and those of 82 healthy subjects. To assess the specificity of the sera autoreactivity, inhibition tests were carried out using free autoantigens. Analysis of sera autoreactivity in patients with nasopharyngeal carcinoma and in control subjects showed that 23% of the patients had serum reactivity against more than 1 autoantigen tested compared to 1.2% in the control group (p = 10(-4)). The most frequent auto reactivity in patient's sera was found with tubulin and nuclear proteins (19.5% and 22% respectively vs. 6.1% and 1.2% in controls). The IgG auto reactivity inhibition studies indicate that all autoantigens, except native DNA, showed low values of IC(50) (concentration of antigen causing 50% inhibition of the antibody binding) reflecting the high affinity of these IgG autoantibodies. When patients and controls were stratified according to their age, IgG autoantibodies to tubulin were found specifically associated with the young age onset of the nasopharyngeal carcinoma (age under 25 years). IgG auto reactivity comparison before and after cancer therapy showed that only anti-tubulin reactivity was significantly affected by treatment. Our results demonstrate that the autoantibodies to the cytoskeleton and nuclear proteins are associated with the nasopharyngeal carcinoma in Tunisians. The anti-tubulin IgG autoantibodies may represent a serologic marker for the nasopharyngeal carcinoma in children and adolescents Tunisians.

While it is well recognized that the combination of amoxicillin and clavulanic acid has been associated with hepatic adverse events, there are only a few reports about amoxicillin alone causing hepatic toxicity. We describe a 34-year-old woman who developed severe cholestatic hepatitis following amoxicillin treatment.

Summary Introduction Benign osteoblastoma (OB) is an unusual primary bone tumor. The preferred locations are the posterior arch of vertebrae and long bones. We report herein an extremely rare location of an OB in the mastoid process of the temporal bone. Case report A 22-year-old woman presented with painful left retro-auricular swelling. Computed tomography features were suggestive of an aggressive osteolytic lesion of the left mastoid. The pathologic examination of bone curettage material revealed a benign OB. A complete resection of the tumor was performed later, with no evidence of recurrence at 1 year. Discussion/Conclusion To our knowledge, this is the 14th reported case of OB confined to the mastoid process of temporal bone. Its histological diagnosis can be difficult and osteosarcoma is its principal differential diagnosis. Although generally regarded as benign, OB has potential for recurrence and local invasion. As such, complete resection, whenever possible, is preferred over conventional curettage.