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Metastatic small bowel tumors are rare. They often present with small bowel occlusion, bleeding, perforation, or intestinal intussusception. Pulmonary adenocarcinoma with metastasis to the small intestine causing intussusception is exceedingly rare. A 72-yearold male patient with a past medical history of left lung adenocarcinoma, presented to the emergency department with abdominal pain and vomiting. On admission, an X-ray of the abdomen without preparation showed some hydroaeric levels on the small intestine. The abdominopelvic computed tomography (CT) scan revealed an ileo-ileal invagination, with an image of the invagination rod. The patient underwent a surgical resection of the small bowel with the removal of the ischemic areas and immediate anastomosis. Macroscopic examination of the surgical specimen revealed five tumor masses varying in size between 1 and 4 cm. The histological examination of the samples taken from these tumors, coupled with an immunohistochemical study confirmed the diagnosis of intestinal metastases of pulmonary origin expressing cytokeratin 7 (CK7) and thyroid transcription factor 1 (TTF1) but negative for CK20, chromogranin, and synaptophysin. The postoperative course was uneventful, and the symptoms transiently recovered. However, the patient died 3 months later. We should consider multiple metastatic lesions in adult intussusception, especially in patients with a past medical history of lung cancer.

Summary Struma ovarii is a monodermal variant of ovarian teratoma. Thyroid-type carcinoma arising in struma ovarii is rare. The most common type is papillary carcinoma, followed by typical follicular carcinoma. A 75-year-old hypertensive patient consulted for the sensation of a painless pelvic mass that has been progressing for six months. The abdominopelvic ultrasound showed a right lateralized abdominopelvic mass measuring 14x13x8 cm with a solid and cystic double component. The patient underwent a unilateral right adnexectomy. Grossly, the tumor was encapsulated and lobulated. On cut sections, it was solid brown whitish in color and gelatinous. On histological examination, it was formed of follicular structures of variable size filled with a dense colloid. From this goiter a malignant tumor proliferation arose, arranged in sheets, trabeculae and follicular structures, and the tumor cells were cubic or polyhedral moderately atypical with few mitotic figures. There were no papillary-like nuclear features. There was focal capsular and vascular invasion. Immunohistochemical study showed positive immunostaining of tumor cells with TTF1. Postoperative course was uneventful. The exact prognosis of thyroid-type carcinoma arising in struma ovarii is still unclear because of its rarity, inadequate follow-up, and the absence of consensus in diagnosis and treatment.

Ovarian teratomas with an extensive solid component in patients aged more than 40 years should raise the suspicion of malignancy. Such specimens should be thoroughly sampled, and the patient must be followed up for a long period.

Pure and mixed fibrolamellar hepatocellular carcinomas display distinct clinical presentations and epigenetic backgrounds leading to different prognoses and as such may be regarded as separate clinical entities.

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.

Misdiagnosis of mucinous cystic neoplasms of the liver may have serious consequences due to their premalignant potential. A thorough understanding of their characteristic features and a high index of suspicion are mandatory (Mod Pathol, 24, 2011, and 1079)., Misdiagnosis of mucinous cystic neoplasms of the liver may have serious consequences due to their premalignant potential. A thorough understanding of their characteristic features and a high index of suspicion are mandatory.

Cystic pancreatic neuroendocrine tumor accounts for 13-17% of pancreatic neuroendocrine tumors and 9-10% of resected cystic tumors. This unusual variant can make clinical diagnosis particularly challenging. A 28-year-old female patient presented with abdominal pain and dyspepsia. General and physical examination was unremarkable. On computed tomography scan a 7.5×5.4×5.2cm thick-walled cystic lesion was noted in the tail region of the pancreas in the stomach bed (A). On the basis of the above findings, the radiologist reported it as suggestive of solid pseudopapillary neoplasm and advised pathological correlation. No abdominal lymphadenopathy was noted. The patient underwent laparoscopic removal of a pancreatic cyst. Intraoperatively, a large cyst was seen located posterior to the stomach in retroperitoneum and was intimately related to the tail of the pancreas. The cyst could be enucleated. On histopathological examination, the sections from the cyst wall showed collagen-rich fibrous tissue in which were embedded small clusters and nests of round cells (B). The cells were monotonous, small to medium in size with amphophilic cytoplasm with indistinct cell borders. The nucleus showed typical stippled nuclear chromatin and no mitoses were noted (C). There was no capsular invasion. Neuroendocrine nature of these round cells was confirmed by performing immunohistochemistry with synaptophysin and chromogranin A (C). Ki67 stained

Background Osteoporosis is a common complication of chronic liver diseases especially associated with Primary biliary cholangitis (PBC). Its occurrence during others autoiummune hepatopathies such us autoimmune hepatitis, primary sclerosing cholangitis has been described. Objectives The aim of our study was to assess the prevalence of osteoporosis in patients with autoimmune hepatopathies. Methods We carried out a retrospective study from January 1996 to December 2018, including all patients with auto-immune hepatopathy [autoimmune hepatitis/Primary biliary cholangitis (PBC)/Primary sclerosing cholangitis (PSC)/overlap syndrome]. Only patients who had bone mineral density (BMD) were selected. Results During the study period, 124 patients were included. The mean age of our patients was 55 years [18-87]. BMD has been realised in 51 patient [32 PBC/5AIH/3PSC/11 overlap Syndrome]. It was normal in 18 cases (35%), whereas 9 patients had osteopenia (18%) and 24 had osteoporosis (47%)[15PBC/2AIH/5overlap/2PSC]. The mean values of L2-L4 T-scores and femur total T-scores were -3.27 and -1.97, respectively., Osteoporotic patients had an average age of 58 years: 1 men, 3 premenopausal, and 20 postmenopausal women. The study of risk factors of osteoporosis has shown that 5patients underwent systemic corticosteroid. A tobacco intoxication has been noted in 1patient. Biochemical analysis indicated a high level of cytolysis (superior to twice normal value) in 14 patient. Cholestasis was noted in 10 patients. The mean values of bilirubin was 23mg/l. Among the 24 patients with osteoporosis, 10 had positif antinuclear antibodies, 17 had positif anti-mitochondrial antibodies and 5 had positif anti-smooth muscle antibodies. Eight of patients were at an advanced stages of liver fibrosis at the moment of diagnosis. Conclusion Our study has shown that autoimmune liver diseases has an influence on bone mineral density as a bone nineral loss was noted in more than half of the cases. It should be considered for all patients with auto immune hepatopathy especially with long duration of corticosteroid treatment. Disclosure of Interests None declared

Background: Autoimmune liver diseases are considered as a group of hepatobiliary injuries mediated by abnormal immunity in subjects with genetic predisposition. It mainly includes autoimmune hepatitis, primary biliary cholangitis,primary sclerosing cholangitis and overlap syndrome. They are oftently associated with different manifestations of autoimmune systemic diseases such as systemic lupus erythematosus, CREST syndrome …. Objectives: The aim of this study was to evaluate the prevalence and the characteristics of systemic diseases associated with autoimmune hepatopathies Methods: We carried out a retrospective study from January 1996 to December 2018 including all patients with autoimmune liver diseases followed in our department: 64primary biliary cholangitis (PBC), 22 autoimmune hepatitis (AIH), 23 overlap syndrome (OS), 15 primary sclerosing cholangitis (PSC). Results: One hundred and twenty four patients were included in our study : 107 women and 17 men with an average age of 55 years [18-87 years]. An immunological disorder was found in 58 cases (48%): [28 PBC/12 AIH/12 OS/6 PSC] with a female predominance (Sex ratio (Men/Women) = 0.09). Systemic diseases included respectively: Sjogren’s syndrome in 20 cases, systemic lupus erythematosus in 7 cases, rheumatoid arthritis in 5 cases, CREST syndrome in 11 cases and autoimmune thyroiditis in 2 cases. The discovery of autoimmune disorder was in most cases concomitant to the diagnosis of the autoimmune liver disease (67%). Our study showed biological assessment perturbation in 20 cases with positivity of : anti-centromere antibodies (11 cases), anti-SSA antibodies (5 cases), anti-cardiolipin antibodies (4 cases) and rheumatoid factor (5 cases) Conclusion: Our study shows a strong prevalence of systemic disease during autoimmune hepatopathies. A systematic screening for clinical and biological immune manifestations are highly recommended in those patients. Disclosure of Interests: None declared

Background: The prevalence of Sicca Syndrome (SS) in patients with Chronic Hepatitis C (CHC) ranges from 5% to 33%. A link between hepatitis C virus (HCV) and SS was evoked given the strong association of these two pathologies with mixed cryoglobulinemia (MC) on one hand and with the salivary tropism of HCV on the other hand. Objectives: To study the prevalence and the characteristics of Sicca Syndrome during CHC. Methods: All patients suffering from CHC followed over a period of 11 years (2002 – 2012) were retrospectively included. Only patients having clinical SS (xerostomia and/or xerophthalmia) were selected. We have analyzed all data concerning the patient, the hepatitis and the SS. Results: Two hundred and four patients affected by CHC were included. A clinical SS was found in 17 patients (8.39%). There were 15 women and 2 men with an average age of 45.6 years. A High viral load and an advanced hepatic fibrosis were respectively found in 94 and 88% of cases. Cryoglobulinemia and antinuclear antibodies were found in 37.5% and 53% of patients, respectively. Four patients (3 women and 1 man) had also presented the criteria of Sjogren Syndrome. Their average age was 47 years. MC was positive in all 4 patients whereas anti-SSA and anti-SSB were absent in the 4 patients. Biopsy of accessory salivary glands revealed the presence of a grade 4 lymphocytic sialadenitis according to the Chisholm and Masson classification in 3 patients, while the remaining case had a lymphocyte grade 2 sialadenitis. The evaluation of hepatic fibrosis did not reveal cirrhosis in the 4 cases. Conclusion: The prevalence of Sicca syndrome during hepatitis C is estimated at 8% in our study. It was mainly reported in women with perimenopausal age and seems to be associated with cryoglobulinemia, a high viral load and and an advanced fibrosis. Disclosure of Interests: None declared

Background: Reynolds syndrome is a rare condition defined by the association of primary biliary cholangitis (PBC) with CREST syndrome. The frequency of scleroderma during PBC varies between 3 and 17%. The diagnosis is most often done during systematic search for autoimmune diseases associated with CBP. Objectives: To determine the epidemiological, clinical, paraclinical and evolutionary features of Reynolds syndrome Methods: We report 7 cases of Reynolds syndrome collected in the our department between 1996 and 2014 Results: There were 7 middle-aged women with an average age of 49.2 years (32-61 years old). The diagnosis of CREST syndrome with anti centromeric positive antibodies was retained in 6 cases. Extensive trunk sclerosis associated with diffuse sclerodacty and anti centromeric antibodies was noted in 1 case. An isolated acrosyndrome was noted in 1 case. The hepatic assessment found non icteric cholestasis in 6 patients. Anti-mitochondrial antibodies type M2 were positive in 6 cases. Liver biopsy showed histologic lesions consistent with primary biliary cholangitis PBC in 5 cases. Sjorgen’s syndrome was confirmed histologically in 1 case. Autoimmune diseases (rheumatoid arthritis and lymphocytic thyroiditis) were associated with Reynolds Syndrome in 2 cases. The treatment consisted of ursodeoxycholic acid alone (N = 4), or combined with D-penicillamine (N = 1), azathioprine-associated prednisone (N = 1) or a calcium channel blocker alone (N = 1). The evolution was favorable in 2 cases. In the other 3 patients, worsening of cholestasis and complications such as oedemato-ascitic decompensation and gastrointestinal haemorrhage were noted during the course of the study. One patient died of cataclysmic gastrointestinal bleeding by rupture of oesophageal varices. Conclusion: Reynolds syndrome is a rare entity that should be discussed in the presence of liver function disturbances in patients with CREST syndrome. Conversely, the CREST syndrome should be referred to and sought systematically in case of PBC. Disclosure of interests: None declared

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.

Pathologic evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The aim of the present study was to determine the incidence and type of pathologic diagnoses found in appendectomy specimens at our institution. The clinicopathological data of 1627 patients who underwent appendectomies for presumed acute appendicitis from January 2008 to October 2014 were reviewed retrospectively. There were 986 men and 641 women (sex ratio M/F = 1.5) aged between 16 months and 90 years (mean = 30 years). All patients underwent appendectomy (either open or laparoscopic). Histological examination of the surgical specimen showed acute inflammation of the appendix in 1455 cases (89.42 %), fibrosed appendix in 37 cases (2.27 %), and Enterobius vermicularis (n = 23). In 101 cases (6.2 %), the appendix was histologically normal. Incidental unexpected pathological diagnoses were noted in 57 appendectomy specimens. They included pinworm (n = 23), mucinous neoplasms (n = 12), neuroendocrine tumors (NET) (n = 8), adenocarcinoma (n = 2), granulomatous inflammation (n = 5), tuberculosis (n = 2), hyperplastic polyp (n = 1), tubular adenoma (n = 1), diverticulitis (n = 1), endometriosis (n = 1), and actinomycosis (n = 1). The routine histopathological examination of the appendix is of value for identifying unsuspected conditions requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic exam. It is recommended that in order to avoid misdiagnoses, all appendices should be histopathologically examined.

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.

Many case reports describe tuberculosis (TB) co-existent with a malignant neoplasm. However, the neoplasm in most of these reports is lung or breast cancer, with only two cases of liver cancer concomitant with TB reported in the literature. Although both TB and cancer are very common diseases, little attention has been given to the pathophysiologic and practical implications of their co-existence.Case report and literature review.A 73-year-old female patient with a history of hypertension and hepatitis C presented with abdominal pain of 2 mos duration. Laboratory findings showed an elevated serum concentration of α-fetoprotein. A computed tomography scan demonstrated a solitary hypodense tumor in the right lobe of the liver (segment VIII). A pre-operative chest radiograph was within normal limits. The patient underwent an uneventful tumor resection. Histologic examination of a surgical specimen of the tumor demonstrated a moderately differentiated hepatocellular carcinoma co-existent with caseating granulomas.Through this case report, the authors discuss the pathogenesis of the rare association of TB and malignant neoplasm of the liver, and present a review of the current literature on the association of TB and cancer. Further research is required to determine whether a TB infection resembles other chronic infections and inflammatory conditions in having a potential to facilitate oncogenesis.

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

Il s’agit d’une patiente âgee de 27 ans, admise pour un nodule indolore du quadrant superoexterne dusein droit decouvert fortuitement. L’examen clinique du nodule n’objectivait ni de retraction du mamelon, ni d’ecoulement mamelonnaire, ni d’adenopathie axillaire. La patiente beneficiait d’une tumorectomie suivie d’une mastectomie de type Patey. L’examen anatomopathologique concluait a un carcinome lobulaire a cellules pleomorphes. Le carcinome lobulaire du sein a cellules pleomorphes est une varieterare du cancer mammaire recemment individualisee, dotee d’un potentiel evolutif particulierementagressif. Il s’organise sur le plan architectural comme un cancer lobulaire invasif, avec cependant, un pleomorphisme cytonucleaire tre s marque posant des problemes de diagnostic differentiel avec le carcinome canalaire infiltrant peu differencie. L’E-cadherine est d’un apport considerable, elle permet en effet de trancher entre ces deux entites dont les modalites therapeutiques et evolutives sont tres differentes.

Calcinosis cutis is a term used to describe a group of disorders in which calcium deposits form in the skin and may be classified as dystrophic, metastatic, idiopathic or iatrogenic calcification, and calciphylaxis. Idiopathic calcinosis cutis occurs without any underlying tissue damage or metabolic disorder. In this paper, the authors report a new case of idiopathic calcinosis involving the medial canthus of the left eye that was mistaken for milia. An 18-year-old previously healthy male patient, presented with an asymptomatic whitish solitary tumour of the medial canthus of the left eye. The patient had no systemic or trauma history, and the serum levels of calcium and phosphorous were normal. An excisional biopsy was performed and histopathologic examination revealed subepidermal calcinosis. Calcinosis cutis is a rare condition that should be included in the differential diagnosis of a benign-appearing lesion of the face. While it can occur in patients with a history of inflammation, trauma, or hypercalcemia, its etiology can also be idiopathic.

Cerebral hydatidosis is a rare parasitic disease representing only 1–2 % of all cerebral space-occupying lesions. It is still a major health problem in infected areas of the world, especially in rural areas. The vast majority of patients affected are children. They present with a wide range of clinical manifestations which mainly depend on the location and size of a given hydatid cyst. Computed tomography and magnetic resonance imaging have greatly contributed to a more accurate diagnosis of hydatidosis. Yet the gold standard of diagnosis remains a pathological one. Extirpation of the intact cyst is the treatment of choice, resulting in most cases to a complete recovery. Despite the introduction of modern surgical and pharmacological therapy, brain hydatid disease continues to be a substantial cause of morbidity and mortality in many parts of the world. Such a serious health problem should enhance endemic areas to develop more efficient preventive measures throughout rural areas in order to reduce mortality rates due to this disease.

Sir,Florid tubal epithelial hyperplasia is a proliferation of the mucosa of the fallopian tube included in the 2003 World Health Organization (WHO) classification of tumours of female genital organ...

Resume But Etudier les caracteristiques epidemiologiques des kystes hydatiques extrapulmonaires dans notre etablissement en comparant nos resultats aux donnees de la litterature. Methodes Notre etude retrospective a porte sur 265 kystes hydatiques extrapulmonaires colliges dans notre service, sur une periode de 18 ans (1990–2007). Resultats Nos patients se repartissaient en 101 hommes et 164 femmes (sex-ratio H/F = 0,61), avec un âge moyen de 38,7 ans. Les sites de predilection des kystes hydatiques de notre serie etaient representes par le rein (24,1 %), le systeme nerveux central (22,6 %), le foie (19,6 %) et la rate (11,3 %). Conclusion La particularite de notre serie tient a la frequence relativement importante des kystes hydatiques du rein et du systeme nerveux central par rapport au foie qui occupe le troisieme rang. De tels resultats inhabituels pourraient etre attribues a un biais de selection.

Squamous cell carcinoma arising in mature cystic teratoma of the ovary is an uncommon complication occurring usually in elderly woman. We present an unusual case of a post-menopausal woman with a synchronous mediastinum teratoma. While ovary tumor was symptomatic, mediastinal teratoma was an incidental finding. To the best of our knowledge, this association is the first to be reported in literature.

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.

Collagenous gastritis is a rare entity of unknown etiology characterized histologically by the presence of a thick subepithelial collagen band associated with an inflammatory infiltrate of gastric mucosa. A 40-year-old male presented with a history of chronic intermittent abdominal pain for about 6 months. Physical examination was unremarkable, and biological tests were within normal range. The patient underwent esophagogastroduodenoscopy and colonoscopy which showed a nodular mucosa of the stomach. Biopsies of the duodenum and colon were unremarkable. However, biopsies of the gastric fundus revealed a mild chronic gastritis characterized by lymphocytic and plasma cell infiltration of deep mucosa, without lymphoid follicle formation or active inflammation. No microorganisms were identified on routine hematoxylin and eosin or Giemsa-stained sections. Subepithelial collagen in the gastric biopsies was thickened and showed entrapped capillaries. Subepithelial collagen was highlighted by Masson’s trichrome staining and was negative for amyloid by Congo Red. In the areas containing thickened collagen, there were no intraepithelial lymphocytes. The final pathological diagnosis was collagenous gastritis. Collagenous gastritis is an extremely rare disease, but it is important to recognize its characteristic endoscopic and pathologic findings to make a correct diagnosis. Specific therapy for this rare entity has not yet been established.

Schistosomiasis is a water-borne trematode infestation and is one of the most widespread parasitic diseases in the world. Schistosomiasis can affect any organ, but is rare in the appendix. In this paper, the authors report a new case of appendicular schistosomiasis that was incidentally discovered in a 27-year-old male patient from Mali who underwent appendectomy for acute appendicitis. Appendectomy specimens removed from patients with appendicular schistosomiasis often appear macroscopically normal, but histopathological analysis of these cases confirms the diagnosis by revealing schistosomal eggs. The authors strongly recommend that all appendectomy specimens be examined histopathologically regardless of whether the specimens are macroscopically normal.

Serrated lesions morphologically analogous to those seen in the colorectum are found in the appendix. Appendiceal hyperplastic polyps are very rare, and their true incidence is unknown. A 52-year-old male previously healthy patient with no particular past medical history, presented with a 24-h history of abdominal pain localized to the right lower quadrant. On physical examination, he was tender to palpation in the lower right quadrant. As acute appendicitis was highly suspected, laparoscopic appendectomy was performed. Histological examination of the surgical specimen showed acute inflammation of the appendiceal wall. The crypts were focally elongated but relatively straight with serrations that were visible mainly near the luminal end of the crypts. Columnar cells with or without apical mucous vacuoles alternated with large goblet cells. The crypt bases were not serrated and were lined by regular cells with small nuclei. The muscularis mucosa was intact. The postoperative course was uneventful, and the patient was discharged on postoperative day 1. The final pathological diagnosis was acute appendicitis associated with hyperplastic polyp. Hyperplastic lesions of the appendix are often incidental findings although they can be associated with acute appendicitis. They are significantly associated with adenocarcinoma elsewhere in the large intestine and the finding of mucosal hyperplasia in an appendectomy is an indication for further investigations to exclude colorectal neoplasia.

Actinomycosis is a chronic suppurative granulomatous infection caused by Actinomyces israelii, an anaerobic Gram-positive microorganism. Pelvic actinomycosis is rare and constitutes 3% of all human actinomycosis infections. Pre-operative diagnosis is usually difficult with the majority of cases being diagnosed after the histological and bacteriological examination of the resected specimen. In this paper, the authors report a new case of tubo-ovarian actinomycosis in a 42-year-old woman that was misdiagnosed pre-operatively as ovarian malignancy. Tubo-ovarian actinomycosis should be considered in patients with a pelvic mass especially in ones using intra-uterine devices. Surgeons should be aware of this infection in order to avoid excessive surgical procedures.

Background: Cystic neoplasms of the pancreas are rare and constitute approximately 0.5% of all pancreatic neoplasms. Aims: The study was to describe clinicopathological features of pancreatic cystic tumors. Patients and Methods: In our retrospective study, we reviewed 10 cases of pancreatic cystic neoplasms that were diagnosed at the pathology department of Mongi Slim hospital over a 14-year period (2000-2013). We adopted the latest World Health Organization (WHO) classification (2010) in grouping all tumors. Results: There were one male and nine female patients (sex ratio M/F = 1:9) aged between 21 and 68 years (mean = 37.5 years). The most common clinical presentation was epigastric and abdominal pain ( n = 6) followed by vomiting ( n = 3). Abdominal computed tomography (CT) scan disclosed a cystic lesion of the pancreas ranging in size between 2 and 10 cm (mean = 6.75 cm). All patients underwent surgical treatment. Histopathological examination of the surgical specimen established the diagnosis of solid pseudopapillary neoplasm ( n = 2), serous cystic neoplasm ( n = 2), mucinous cystadenoma ( n = 4), mucinous cystadenocarcinoma ( n = 1), and intraductal papillary mucinous neoplasm with invasive carcinoma ( n = 1). Conclusion: Better understanding of pancreatic cystic neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

Biliary hamartomas or von Meyenburg complexes are uncommon benign biliary malformations, which are considered as part of the spectrum of fibrocystic diseases of the liver due to ductal plate malformation. Development of intrahepatic cholangiocarcinoma is well described in these complexes. However, only 10 cases of hepatocellular carcinoma arising in association with von Meyenburg complexes have been described in the English-language literature to date. In this paper, the authors report a peculiar case of hepatocellular carcinoma occurring on a background of von-Meyenburg's complexes and solitary unilocular bile duct cyst. It is not clear whether development of hepatocellular carcinomas is an epiphenomenon unrelated to the precursor lesion or biliary hamartomas may progress to liver cancers. Further studies are mandatory so as to elucidate and consolidate this very rare association.

Xanthogranulomatous cholecystitis is an uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions that may be confused with a malignant process. In this paper, the authors report a new case of xanthogranulomatous cholecystitis in a 63-year-old female patient that was misdiagnosed per-operatively as gallbladder cancer and treated with extensive excision. The common imaging techniques are not always able to differentiate xanthogranulomatous cholecystitis from gallbladder cancer and the final diagnosis is usually established by histological examination of the resected specimen. This entity should be kept in mind in difficult cholecystectomy cases.

Retroperitoneal paragangliomas are relatively rare endocrine tumours derived from the extra-adrenal paraganglia of the autonomic nervous system. They can be functional when they secrete catecholamines or non-functional. The diagnosis of a paraganglioma is infrequently made preoperatively unless the tumour is functional. In this paper, the authors report a new case of non-functional paraganglioma. A 54-year-old woman with a past medical history of viral hepatitis, presented with vague abdominal pain of five years\' duration. On examination, no abdominal mass was palpable and her blood pressure was 100/60 mm Hg. Abdominal computed tomography scan demonstrated a well-defined hypervascular retroperitoneal mass of heterogeneous density in the left para-aortic region measuring 3cm in diameter. As paraganglioma was suspected preoperatively, serum and urine cathecholamine levels were performed and were within normal range. Complete surgical excision of this mass was performed. Histological examination of the surgical specimen coupled with immunohistochemical study was consistent with the diagnosis of pararganglioma. Retroperitoneal paragangliomas are most commonly benign with good prognosis, but can be locally invasive and metastasize as well. The possibility for malignant transformation of paragangliomas makes surgical excision the treatment of choice.

Only 0.5 to 2% of hydatid cysts are localized in the skeleton and of these, 3 to 4% are found in the skull. In this paper, the authors report a case of primary hydatidosis involving the cranial vault revealed by a bulging mass of the forehead and symptoms of raised intracranial pressure that occurred in a 22-year-old woman who came from a rural area. Through this case and literature review, the authors analyse the epidemiological, clinical and radiological aspects of skull hydatidosis. They conclude that hydatid cyst should be considered in the differential diagnosis of any soft tissue swelling or osteolytic lesion in the scalp of patients living in endemic areas.