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Various studies in western countries found Akt amplification to be a frequent event in human cancers, including bladder, but the correlation with clinicopathological features is controversial. Such studies have not been reported in African populations, including Tunisians. The purpose of this study was to assess expression of the phosphorylated/activated forms of Akt in tumors from Tunisian patients with bladder cancer and to correlate its expression with pathological and clinical parameters of the disease. The study included 72 patients of whom 34 were diagnosed as low- to medium-grade and 35 as high-grade; 30 were muscle stage and 39 non-muscle stage. Primary tumors from these patients, normal adjacent tissues, or bladder cancer cell-lines were analyzed for Ser473 phosphorylated Akt expression by Western blot. Seventy-two percent of primary tumors from patients with bladder cancer had increased levels of p-Akt. The p-Akt levels in patients with high-grade bladder cancer were significantly elevated compared to patients with low- or medium-grade bladder cancer. In invasive carcinoma, the p-Akt level was significantly higher than in superficial non-invasive bladder tumors. Concerning the influence of tobacco on Akt activation, no significant differences of p-Akt expression were found between non-smoker and smoker patients. Altogether, our results suggest that Akt activation can provide useful prognostic information and that tobacco represents a serious risk factor for recurrence in a cohort of Tunisian patients. [ABSTRACT FROM AUTHOR]

Aims: To assess the diagnostic agreement and intra- and interobserver reproducibility of the 1973 and the 2004 World Health Organization (WHO) classifications of Urothelial Papillary Neoplasms of the bladder. Methods: One hundred and two cases of pTa/pT1 papillary urothelial bladder tumours were evaluated retrospectively. Two pathologists reviewed the slides and assigned a tumour grade according to the 1973 and the 2004 WHO classifications. Whenever a discrepancy was noted between the first and the second reading, the two pathologists together reviewed the slides and reached a consensus for the final grading according to the two classifications. Intraobserver variability was assessed by one of the two pathologists who reviewed the slides one month later. Interpretive discrepancies for each category of neoplasm were documented. Degree of agreement and reproducibility were evaluated using intra- and inter-rater techniques (kappa statistic). A value of 0.21-0.40 was accepted as weak, 0.41-0.60 as moderate, 0.61-0.80 as substantial and 0.81-1 as absolute agreement. Results: According to the 1973 WHO classification, the proportions of G1, G2 and G3 tumours were 40.2%, 50% and 9.8%, respectively. According to the 2004 WHO classification, the proportions of tumours of low malignant potential, low-grade carcinomas, and high-grade carcinomas were 23.5%, 60.8% and 15.7%, respectively. The intra-observer reproducibility was excellent for the two classifications (absolute agreement). The degree of agreement between pathologists was higher in the 2004 WHO (kappa = 0.7) than the 1973 WHO classification (kappa = 0.51). Conclusions: The present findings suggest that the new proposed classification system for urothelial papillary neoplasms slightly increases the inter-observer reproducibility. The intra-observer reproducibility is excellent for the two classifications. [ABSTRACT FROM AUTHOR]

Context: Clear cell adenocarcinoma of the urethra is an extremely rare tumour. Its histogenetic derivation remains controversial. Case report: We report a new case of clear cell adenocarcinoma of the proximal urethra in a 56-year-old woman who presented with grossly hematuria. Urethral cystoscopy revealed a tumour protruding from the posterior urethral wall at the bladder neck. Treatment consisted of urethrocystectomy with pelvic lymph node dissection. Histologically, the neoplasm consisted of clear cell adenocarcinoma of the urethra. Conclusion: It appears that female urethral adenocarcinoma has more than one tissue of origin. [ABSTRACT FROM AUTHOR]

Context: Solitary fibrous tumor is a distinct neoplasm, rarely recognized in extrathoracic sites. Case report: The article reports a new case in the retroperitoneum in a 55 year-old man, who presented with urinary symptoms. Tumor was completely excised, and the solitary fibrous tumor was diagnosed after pathologic examination and immunohistochemistry. The patient has remained free of disease for five years since surgery. Conclusion: An uncommon variant of retroperitoneal solitary fibrous tumor with giant multinucleated cells was documented in the study. [ABSTRACT FROM AUTHOR]

Lymphoepithelial carcinoma of the salivary glands is a rare neoplasm that is characterized by a non-neoplastic lymphocytic infiltration associated with an epithelial proliferation. It involves mainly the parotid gland. Racial and geographical factors contribute to the pathogenesis of this tumor. We report a case of a 70-year old woman from a non-endemic area who presented with several months history of swelling in the parotid region. Magnetic resonance imaging showed a parotid mass suggestive of a pleomorphic adenoma. The diagnosis of lymphoepithelial carcinoma of the parotid gland was performed on the surgical specimen. A primitive nasopharyngeal carcinoma was ruled out by random biopsies of the nasopharynx mucosa. The Epstein-Barr virus (EBV) was absent in neoplastic cells. We insist that, even in non-endemic areas and when clinical and radiological characteristics are not suggestive of malignancy, intra-operative frozen section analysis should be used in order to ensure the appropriate treatment. [ABSTRACT FROM AUTHOR]

Although epithelial-mesenchymal markers play an important role in prostate cancer (PC), further research is needed to better understand their utility in diagnosis, cancer progression prevention, and treatment resistance prediction. Our study included 111 PC patients who underwent transurethral resection, as well as 16 healthy controls. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was used to examine the expression of E-cadherin, β-catenin, and Vimentin. We found that E-cadherin and β-catenin were underexpressed in primary PC tissues. E-cadherin expression was found to be inversely associated with prostate-specific antigen progression (PSA-P; serum marker of progression; p = 0.01; |r| = 0.262). Furthermore, the underexpression of two markers, E-cadherin and β-catenin, was found to be associated with advanced tumor stage and grade (p < 0.05). On the other hand, Vimentin was overexpressed in PC patients with a fold change of 2.141, and it was associated with the diagnosis, prognosis, and prediction of treatment resistance to androgen deprivation therapy (p = 0.002), abiraterone-acid (p = 0.001), and taxanes (p = 0.029). Moreover, the current study highlighted that poor survival could be significantly found in patients who progressed after primary surgery, did not use drugs, and expressed these genes aberrantly. In Cox regression multivariate analysis (p < 0.05), a positive correlation between the Vimentin marker and coronary heart disease in PC patients was identified (p = 0.034). In summary, the present study highlights the diagnostic (p < 0.001), prognostic (p < 0.001), and therapeutic potential of Vimentin in primary PC (p < 0.05), as well as its implications for cardiovascular disease. Furthermore, we confirm the potential prognostic value of E-cadherin and β-catenin., (© 2023 Wiley Periodicals LLC.)

Competing Interests: The authors declare no conflict of interest.

Background: Tuberculous spondylodiscitis (TS) is the most common form of musculoskeletal tuberculosis. Currently, histology is widely used to distinguish tuberculous from nontuberculous disease., Objectives: The aim of the present study was to assess the accuracy of histology compared with bacteriology in the diagnosis of TS., Methods: This is a single-center case series carried out from January 2014 to February 2018 in a pathology department. It included 121 discovertebral biopsies of infective spondylodiscitis. The measures of diagnostic accuracy of histology were determined taking bacteriology as criterion standard., Results: Among the 121 cases, 55 (45.4%) were diagnosed as TS by histological and/or bacteriological findings, 17 (30.9%) were classified as definite TS by bacteriology, and the remaining 38 (69.1%) had positive histology and negative bacteriology. There were 2 false-negatives, which histologically displayed suppuration without granuloma, and 3 false-positives; in one case, histology displayed granulomas without necrosis and culture isolated Brucella. In the 2 others, histology revealed granulomas with caseous-like necrosis and microbiology isolated fungal species. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of histology in the diagnosis of TS were 88.2%, 93.4%, 83.3%, 95.5%, and 92%, respectively., Conclusions: Histology is proved to be an accurate diagnostic tool in TS. Suppurative forms of TS without granuloma are rare and represent the main cause of false-negative histology. Suggestive histology of TS does not rule out fungal and brucellar spondylodiscitis. Caseous necrosis is not pathognomonic of tuberculosis. Fungal infection can also exhibit such type of necrosis.

Introduction: Primitive bladder adenocarcinomas account for about 2% of urinary bladder tumors. Primary signet-ring cell carcinoma is a rare variant of bladder adenocarcinoma. It is characterized by a late diagnosis and a poor prognosis. The aim of the study was to discuss the clinical, pathological and evolutive features of this rare entity. Clinical Observations: We report two patients a 53-year-old man and a 70-year-old woman. The main reason for consultation was right back pain, mictional burn and total hematuria. Abdominal ultrasound showed a thickened bladder wall measuring 8 mm in thickness. Ultrasonography revealed a budding intravesical lesion with a calculation of the lower left ureter measuring 5mm of great diameter. Cystoscopy showed an atypical tissular lesion frayed whitish and solid in the cut. Pelvic MRI performed in women showed a cervix ill-limited tissue mass invading the anterior vaginal wall. A transurethral resection of the bladder tumor was performed in one case and a biopsy of the bladder lesion for the other case. The immunohistochemical study showed positive tumoral cells to CK7. The diagnosis of signet ring cell adenocarcinoma of the bladder was established., Conclusion: Signet ring cell adenocarcinoma of the bladder is an aggressive tumor of rapid development and poor prognosis. Its management is multidisciplinary and involves surgery. Adjuvant chemotherapy should be discussed even if consensual attitude has not been set.

Competing Interests: Les auteurs déclarent n’avoir aucun lien d’intérêts.

Background: Oncocytic tumors (OT) are rare, representing 3 to 10% of epithelial tumors of the thyroid. It is important to individualize these TO given the relatively high frequency of carcinomas in this group: 30% against 15% for micro-vesicular lesions of classical cytology and the aggressiveness of malignant OT due to their low iodine uptake., Aim: The aim of our study was to describe the anatomo-clinical aspects of oncocytic tumors of the thyroid., Methods: Our study was retrospective, realized on 99 cases of oncocyte thyroid tumors collected at the Anatomy and Pathology Cytology laboratory of Tunis Charles Nicolle Hospital during a 10-year period (2004-2014)., Results: Our series included: 76 oncocyte adenomas, 13 oncocytic papillary carcinomas, 7 oncocytic carcinomas and 3 tumors of uncertain malignant potential (3%). The correlation of the anatomo-clinical data with the diagnostic categories showed a statistically significant difference concerning the macrovesicular architecture. We found no difference between benign and malignant TO, in relation to age, echogenicity, tumor size, macroscopic appearance, capsule thickness, percentage of oncocyte cells, and the presence of associated lymphocyte thyroiditis., Conclusions: In view of the literature data and the findings of our study, it seems that there are no predictive factors for the malignancy of oncocytic tumors at the pre- and peroperative stage, with the exception of papillary-type nuclear atypia for Oncocytic papillary carcinoma.

Background: The identification essentially of hMSH2 and/or hMLH1 alterations has clinical implications for recognition and prognosis of MSI phenotypes cases. In this study, we tried to identify instability by immunohistochemical expression pattern analysis, compared the results with molecular investigation and shown their usefulness as predictive factors for determination of Microsatellite Instability in patients with colorectal carcinomas in routinely., Methods: Forty seven colorectal cancers and their adjacent colonic mucosa were selected retrospectively for this study. We first studied the potential value of molecular investigation to identify microsatellite instability in which a NCI panel (or Bethesda panel) of five microsatellite was analyzed (Bat-25, Bat-26, D2S123, D5S346 and D17S250). Secondary, we evaluated the immunohistochemical assessment of hMLH1, hMSH2, hMSH6 and PMS2 proteins in tumor and adjacent normal colorectal mucosa tissues., Results: Fourteen cases were scored as MSI and the remaining MSS. Moreover, we found loss of expression for hMLH1, hMSH2, hMSH6 and PMS2 respectively in 9, 10, 6 and 9 of cases. The MSI patients were less than 45 years old, have right localization and mucinous histological type. We found an association between MSH2, age (P=0.03) and staging (P=0.02). MLH1 is associated only with age (P=0.02) while MSH6 with tumor grade (P=0.01)., Conclusions: We found an association between MSI molecular investigation and MMR immunohistochemical expression which may allow one to specifically identify MSI phenotype of patients with colorectal carcinomas. Furthermore, immunohistochemical analysis of MMR protein can be used in routinely for detection of microsatellite instability without occurs to molecular investigation.

Various studies in western countries found Akt amplification to be a frequent event in human cancers, including bladder, but the correlation with clinicopathological features is controversial. Such studies have not been reported in African populations, including Tunisians. The purpose of this study was to assess expression of the phosphorylated/activated forms of Akt in tumors from Tunisian patients with bladder cancer and to correlate its expression with pathological and clinical parameters of the disease. The study included 72 patients of whom 34 were diagnosed as low- to medium-grade and 35 as high-grade; 30 were muscle stage and 39 non-muscle stage. Primary tumors from these patients, normal adjacent tissues, or bladder cancer cell-lines were analyzed for Ser473 phosphorylated Akt expression by Western blot. Seventy-two percent of primary tumors from patients with bladder cancer had increased levels of p-Akt. The p-Akt levels in patients with high-grade bladder cancer were significantly elevated compared to patients with low- or medium-grade bladder cancer. In invasive carcinoma, the p-Akt level was significantly higher than in superficial non-invasive bladder tumors. Concerning the influence of tobacco on Akt activation, no significant differences of p-Akt expression were found between non-smoker and smoker patients. Altogether, our results suggest that Akt activation can provide useful prognostic information and that tobacco represents a serious risk factor for recurrence in a cohort of Tunisian patients.

Background: The deficiency of mismatch repair system is one of the main pathways in colorectal cancer. This system consists mainly of four proteins: MLH1, MSH2, MSH6 and PMS2. Colorectal cancer develops in the majority of cases from precancerous lesions called adenomas. Only few studies have reported on the deficiencies of these proteins in adenomas., Aim: In this study we used immunohistochemistry staining in colorectal adenomas to assay functional status of MLH1, MSH2, MSH6, and PMS2 proteins., Methods: 102 adenomas from 93 patients were collected in our institution during six years (2007-2012). The immunohistochemical technique was performed with 4 antibodies: MLH1, MSH2, MSH6 and PMS2. The loss of expression was retained if adenomatous cells were not stained with positive internal control. Staining was considered as abnormal if nucleus of adenomatous cells showed low nuclear staining and / or heterogeneous one, while positive internal control had normal staining., Results: Loss of expression of MSH2 and MSH6 in adenomatous cells was found in only 1 case which was a tubular adenoma 3mm high-grade dysplasia. Abnormal staining of the adenomatous cells was noted in 23 cases (22.5%) for MSH2 and in 8 cases (7.8%) for MSH6. No cases showed loss of expression of MLH1 and PMS2. Abnormal expression of MSH2 and MSH6 was not correlated with sex of patients, the location of the adenoma, its grade of dysplasia and its histological type., Conclusions: Loss of Mismatch repair proteins expression is a rare event in adenomas. However, the abnormal expression levels are higher in our study compared to those reported in the literature. This could reflect a higher rate of microsatellite instability in our patients. Multicenter and larger studies with molecular biology techniques are needed.

Objective: Odontogenic myxoma is an uncommon tumor that represent less than 0,5% of all bone tumors and only 3 to 6% of odontogenic tumors. The aim of this article was to catalogue the clinical cases diagnosed microscopically as odontogenic myxoma and to describe their clinical and radiographic characteristics, comparing these to the data found in the current literature., Design: Histological and immunocytochemical examinations were performed on odontogenic myxomas from four Tunisian patients in a period of 23 years., Results: In the present series, two were male and two female. The age at diagnosis ranged from 19 to 38 years. Three tumors involved the mandible and one occurred in the maxilla. In all cases with radiographic records, lesions presented with a multilocular and osteolytic appearance. Histologically, odontogenic myxomas were mainly composed of spindled or stellate-shaped cells in a mucoid-rich intercellular and alcian blue positive matrix. All cases were treated by tumor-enucleation. There was no evidence of recurrence after 2 to 8 years., Conclusion: Clinical and radiological aspects of odontogenic myxomas are not conclusive; a histopathological examination of the lesion is mandatory in order to make the right diagnosis. Because of its high rate of recurrence, surgical treatment through bone resection is the most indicated treatment modality, and the patient must be followed-up closely for years., (2010 Elsevier Masson SAS. All rights reserved.)

Background: Solid pseudopapillary tumors of the pancreas are extremely rare and mostly seen in young females. It is often diagnosed incidentally or during investigations of gastrointestinal complaints., Aim: Report of a pediatric case of this tumor., Case Report: We report the case of a 15-year old teenager who presented with painful abdominal tumefaction. Imaging findings were a 12 cm solid and cystic mass originating from the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. Pathologic examination concluded to solid pseudopapillary tumor. Evolution was favorable with no recurrence 18 months after surgery., Conclusion: Histological examination confirms the diagnosis and allows, with the help of immunohistochemical study, to rule out some differential diagnoses such as pancreatoblastoma, acinar tumors and endocrine tumors. Prognosis of solid pseudopapillary tumors of the pancreas is excellent after radical resection and recurrences are rarely seen.

Castleman disease or angiofollicular lymph node hyperplasia is a rare disease of unknown cause with polymorphic clinical features that raises many diagnostic and therapeutic problems. The unifocal, localized, pseudoneoplastic form, first described in 1956, has a good prognosis, but the multifocal form has a more aggressive course. Three histological types have been identified: hyaline vascular, plasma cell and mixed. The authors present a case of hyaline vascular unifocal Castleman disease. A retroperitoneal mass was discovered incidentally during follow-up ultrasound examination in a 38-year-old woman treated for recurrent renal stones. On CT examination, a solid mass measuring 9 x 8 x 6 cm raised a problem of differential diagnosis with other retroperitoneal masses. CT-guided biopsy was inconclusive and the diagnosis was finally established by tumour excision and histological examination. The immediate and subsequent postoperative course was uneventful.

Fibrolamellar carcinoma (FLC) of the liver is a rare variant of hepatocellular carcinoma (HCC) occurring on non cirrhotic liver. Since its first description by Hugh Edmondson in 1956, 200 cases of FLC have been reported in the literature, but only some cases describe the association of the ordinary HCC with the FLC within the same lesion. We report in this study the case of a 14-year-old female patient with a hepatic mass whose radiological aspect evoked a nodular and focal hyperplasia. Histologically, this tumor was composed of area of FLC mixed with ordinary HCC. Staining for cytokeratine 7 was positive in the FL component and negative in the ordinary HCC component.

Desmoplastic small round cell tumor (DSRCT) correspond to a recent clinicopathological entity, individualized in 1989 into the group of tumors with small round cells. This pathology puts ethiopathogenic, diagnostic, therapeutic and prognosis problems. Indeed, the ethiopathogenic is still unknown, diagnosis is asserted only by immuno-histochimic and cytogenetic study because of the big number of differential diagnoses and the anatomopathologic polymorphism. Its treatment is not well codified and its outcome remains dark in spite of therapeutic progress. The objective of this work is to report a personal observation of a DSRCT and to proceed to a review of the literature to clarify the epidemiological, clinical, paraclinical and therapeutic aspects of this rare tumor., (Copyright John Libbey Eurotext 2003.)

The purpose of this study was to evaluate the prevalence of Epstein-Barr virus in Hodgkin disease in Tunisia through a series of 77 cases. Association with Epstein-Barr virus was demonstrated by Epstein-Barr encoded early RNA transcripts (EBER) in situ hybridization in 70% of cases and by latent membrane protein 1 (LMP1) immunohistochemistry in 58.4% of cases. EBER positive cases were more frequent in extreme age classes (<15 and>54 years) there was no correlation with sex, histologic sub-type and clinical stage. Our findings show a high prevalence for EBV infection in Tunisian Hodgkin's disease particularly among extreme ages.