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In Tunisia, hydatid cyst is an endemic parasitic disease. The cyst may remain asymptomatic, discovered accidentally, or in case of a complication, the most serious of which is sudden death. We propose, in this article, to analyze the degree of involvement of the cyst in the mechanism of death, through the review of 25 cases. A total of 7932 autopsy cases were performed during the study period. Twenty-five cases of hydatid cyst discovered at autopsy were collected and death was attributed to hydatid cyst in 13 cases. The seat of the cyst was variable and death was due to anaphylaxis in 10 cases, to hydatious embolism in 2 cases and to cardiac arrhythmia, resulting from a cardiac localization of a large hydatid cyst, in 1 case.Although rare, echinococcosis can be a life-threatening disease. Its involvement in the death mechanism remains difficult in many cases.

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.

Little is known about the relationship between arginase, an immunosuppressive enzyme, and cervical lesions. The present study is aimed at evaluating arginase activity in plasma and mRNA arginase isoforms expression in cervical cells of patients with abnormal cytology and identifying their relationship with Human papillomavirus (HPV) related parameters such as: HPV type, HPV circulating viral load and anti-HPV16 IgG.This study included 77 women with cervical lesions and 95 matched controls. Arginase activity was detected by colorimetric assay. Arginase mRNA expression and HPV viral load were evaluated by quantitative real time PCR and anti-HPV16 antibodies were assessed by ELISA.Compared to controls, the arginase activity was higher among women with cervicitis / low grade squamous intraepithelial lesions (LSIL) (OR: 1.872, 95% CI: 0.833-4.210), and also among women with high-grade squamous intraepithelial lesions (HSIL) / squamous cell carcinoma (SCC) (OR: 3.358, 95% CI: 1.670-8.910). Compared to controls, mRNA expression was significantly upregulated in women with cervical cervicitis and SIL for ARG1, and in women with cancer lesions for ARG2. Arginase activity was positively correlated to ARG2 mRNA expression but not to ARG1. High arginase activity was associated with HPV16, high levels of HPV viral load, and low levels of anti-HPV16 antibodies.Our findings demonstrated that arginase activity and isoforms expression were enhanced in women with HPV-related precancerous lesions and cervical cancer. Further studies are needed to identify how arginase enzyme induces disease progression and severity.

Cirrhosis cardiomyopathy is defined by cardiac dysfunction in cirrhotic patients. It is characterized by the reduced contractile response to stress and/or impaired diastolic relaxation associated with electrophysiological disturbances with unknown cardiac disease. Here we report a case of sudden death in a 44-year-old woman, with no personal and family medical history and in apparently good health before death. The death was occurred when performing agricultural activities. The autopsy revealed an elevated weight of the heart with heterogeneous myocardium. The liver was heavy and had a variegated appearance. The histologic examination showed fibrosis and partially disturbance of the texture of the left ventricular myocardial tissue with storiform patterns and circumscribed hypertrophic cardiomyocytes. The microscopic examination of the liver showed cirrhosis with no specific features of etiology. The death was attributed to arrythmia due to cirrhotic cardiomyopathy. Our case highlighted the importance of pathological examination to con-sider the diagnosis of cirrhotic cardiomyopathy in case of sudden death for patient with known or unknown cirrhosis.

Splenic cysts are infrequent and most of them are related to parasitic diseases. Splenic epithelial cyst (SEC) is the most common type of primary non-parasitic splenic cysts. Its pathogenesis is not yet clear. Splenic cysts are usually asymptomatic and are detected incidentally during imaging exams or an exploratory laparotomy.Our case is about a primary SEC discovered incidentally. An 18-year-old male patient without any personal and family medical history, presented with symptoms of upper urinary tract infection. Renal ultrasound was performed and found incidentally a solitary cystic lesion in the spleen. A laparoscopic partial splenectomy was made then. The specimen was sent for pathological examination and a diagnosis of primary (epidermoid) epithelial splenic cyst was given.SEC is a rare pathology that could mimic other splenic cysts like hydatid cyst. The preoperative diagnosis of SEC can be suspected by ultrasonography, computed tomography or magnetic resonance imaging. However, histopathological examination is mandatory to confirm the diagnosis. A wide range of differential diagnoses is considered when we suspect clinically SEC because of its lower incidence.Actually, spleen-preserving surgery with minimally invasive methods such as laparoscopy is the gold standard for the treatment of SEC despite the risk of recurrence encountered with these techniques. However, different surgical modalities are discussed depending on the size and the location of the cyst and the patient's age.

Insuline-like growth factor I (IGF1) is a peptide growth factor that promotes cell proliferation and inhibits apoptosis.To examine the association of genetic variants in IGF1 (rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722) with risk of colon cancer in Tunisia.The study included 76 formalin-fixed paraffin embedded primary colorectal carcinomas and paired normal colon. The five IGF1 polymorphisms were determined by polymerase chain-restriction fragment length polymorphism (PCR-RFLP).A significant differences in genotypes and alleles frequency of the five examined IGF1 polymorphisms was determined between tumor and healthy tissues of colon cancer patients (P0,01). While, no significant association was found between genetic variation in IGF1 variants and clinic-pathological parameters in tumors tissues. Expect for rs2373722, a statistically significant correlation was detected between tumor localization and the presence of the (A) mutated allele (OR=0,49; 95% CI 0,25-0,99; P=0,03).This analysis shows that IGF1gene polymorphisms rs12423791, rs1019731, rs5742632, rs2033178 and rs2373722 are associated with the risk of colon cancer in Tunisian population.

Background Pancreatic ductal adenocarcinoma (PDAC) has a devastatingly poor prognosis. Surgical resection is undertaken in only 20% of patients. Most of well-known prognostic factors reflect tumor stage more than its biology. So it is important to identify new biological indicators related to survival in order to develop new therapies. Objective To determine the relation between tumor budding and Epithelial Mesenchymal Transition (EMT) and to evaluate their impact on survival for patients after resection of PDAC. Methods We herein report a retrospective study of 50 patients with resected PDAC. Tumor budding, immunohistochemical expression of vimentin and other standard factors were correlated with survival using the Kaplan-Meier method and Cox multivariable survival analysis. For tumor budding assessment, an inter-observer variability study was performed using 100 images of tumor slides stained with Hematoxylin & Eosin and Pan-Cytokeratin. Results Tumor budding was present in all tumors. A substantial agreement between six pathologists was established in distinguishing high-grade from low-grade budding (κ = 0.6 and 0.73 for H&E and PCK images respectively). High-grade budding was identified in 56% of tumors (28/50). It was an adverse prognostic factor independent of tumor size, resection margins status, nodal status and vascular invasion (p = 0.008). Tumor budding was significantly associated with vimentin expression (p = 0.002). Conclusions The association of tumor budding with vimentin expression supported the idea that EMT is a key process in PDAC responsible for progression and drug resistance. Consequently, the elucidation of EMT molecular biology and development of new targeted therapy may improve disease outcome.

Introduction Le Xanthoma Disseminatum (XD) est une maladie systemique habituellement normo lipidique revelee souvent par l’atteinte cutanee. Nous rapportons un cas de XD associe a une dyslipidemie. Observation Un patient de 56 ans, hypertendu et diabetique sous antidiabetiques oraux, consultait pour des nodules xanthomateux, repartis symetriquement sur le visage, en regions periorificielles, sur le cou et les plis axillaires d’evolution progressive depuis 03 mois. L’examen general etait sans anomalies. A la biologie on notait une hypertriglycediremie a 2 fois la normale et une note d’hypercholesterolemie totale. Le reste du bilan (notamment thyroidien) etait sans particularites. Une biopsie cutanee confirmait le diagnostic de XD. Un traitement hypolipemiant associe a un regime hygieno-dietetique etait instaure ainsi qu’une excision chirurgicale des lesions les plus genantes. Discussion Le XD est une forme d’histiocytose non langerhansienne rare et benigne qui peut survenir a tout âge mais touche preferentiellement les hommes jeunes. Le XD touche electivement la peau, les muqueuses, l’hypothalamus et l’hypophyse dont l’atteinte est responsable d’un diabete insipide. Des cas associes a des pathologies thyroidiennes ont ete rapportes. Le plus souvent aucune perturbation du bilan lipidique n’est trouvee, mais de rares cas rapportent l’association d’un XD a une anomalie lipidique. L’evolution est chronique et le pronostic depend de l’etendue et surtout de l’atteinte extra-cutanee. Les lesions cutanees isolees peuvent etre traitees par excision chirurgicale ou ablation au laser CO2. L’efficacite des corticoides oraux, des immunosuppresseurs dans des formes dissemines a ete rapportee ainsi que des traitements hypolipemiants dans des formes dyslipidemiques.

Introduction: Les objectifs de notre travail sont d’evaluer l’impact pronostic de la profondeur d’infiltration tumorale du chorion et de l’envahissement ou non de la musculaire muqueuse des tumeurs pT1 de la vessie en etudiant les taux de recidive et de progression, les survies globale, sans recidive et sans progression. Patients et Methodes: La relecture de toutes les lames a ete effectuee pour determiner la presence ou non de la musculaire muqueuse, son envahissement (pT1b) ou non (pT1a) et la profondeur d’envahissement du chorion (pT1 m: envahissement unifocal ≤ 0,5 mm ou pT1e: envahissement unifocal > 0,5 mm ou multiple). Resultats: En fonction de l’invasion de la musculaire muqueuse, les taux de recidive et de progression etaient plus frequents pour les tumeurs pT1b par rapport a celles pT1a, avec un taux de recidive de 84.6% (p = 0,0012) et de progression de 38.5% (p = 0,003). En fonction du degre d’invasion du chorion, la recidive et la progression etaient plus frequentes pour les tumeurs pT1e par rapport a celles pT1 m (respectivement 57.2 (p = 0,05) et 17.9% (p = 0.11)). La survie moyenne sans recidive etait de 70.3 mois pour les tumeurs pT1a et 53.6 mois pour celles pT1b (p = 0,046), et elle etait de 61.7 mois pour les tumeurs pT1e et de 55.5 mois pour celles pT1 m (p = 0,85). Conclusion: Le classement des ces tumeurs en fonction de l’importance d’envahissement du chorion et del’infiltration de la musculaire muqueuse a prouve son efficacite a travers les taux de recidive et de progressiontumorale chez nos malades. Mots cles: tumeur vesicale; survie; recidive; progression de la maladie English Title: Prognostic interest of tumoral infiltration depth of chorion in the evolution of pT1 bladder tumors English Abstract Introduction: The aim of our study was to evaluate the prognostic impact of tumor infiltration depth of the lamina propria and invasion or non-invasion of the muscularis mucosa of pT1 bladder tumors, studyingrecurrence and progression rate, overall survival, disease-free survival and progression-free survival. Patients and methods: All slides were reviewed to determine the presence or absence of muscularis mucosa,invasion above (pT1a) or below (pT1b) the muscularis mucosa, and the invasion depth of the lamina propria (pT1m: a single focus of lamina propria invasion ≤0.5 mm, pT1e: single focus >0.5 mm of lamina propriainvasion or multiple micro-invasive area). Results: Depending on the invasion of the muscularis mucosa, the rate of recurrence and progression wasmore frequent in pT1b tumors in comparison to patients classified pT1a, with a recurrence rate of 84.6% ( p = 0.0012) and a progression rate of 38.5% ( p = 0.003). Depending on the degree of invasion of the laminapropria, the rate of recurrence and progression was more frequent for pT1e tumors in comparison to pT1m,with a recurrence rate of 57.2% ( p = 0.05) and a progression rate of 17.9% ( p = 0.11). Disease-free survivalwas 70.3 months for pT1a tumors against 53.6 months for pT1b tumors ( p = 0.046), and it was 61.7 monthsfor pT1e tumors against 55.5 months for pT1m tumors ( p = 0.85). Conclusion: The classification of bladder tumors based on the invasion of the lamina propria has provedits efficiency through the recurrence rate and the progression rate among our patients. Keywords: urinary bladder neoplasms, survival analysis, recurrence, disease progression

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.

Hemosiderotic fibrohistiocytic lipomatous tumor (HFLT) is a rare and supposedly benign fibrolipomatous entity. Clinical and imaging features are not specific. So, histologic, immunohistochemical and molecular analyses are required for diagnosis. The clinic and pathologic aspects of this lesion are diversely reported. Moreover, its reactive or neoplastic origin is still under debate. This lesion should be treated by complete excision. It is mandatory to be aware of its tendency to harbor higher-grade lesions with aggressive outcome. We report a case of HFLT affecting the dorsum of the third right finger in a 52-year-old women, in order to describe histologic patterns of this tumor and to discuss the current literature regarding the etiopathogeny and the cytogenetic features of this rare entity.

Resume Les proliferations myofibroblastiques de la vessie chez l’adulte sont des lesions rares d’evolution benigne. Ces proliferations, qu’elles soient d’apparition spontanee ou secondaire a une instrumentation, ont une morphologie et un comportement identiques. Plusieurs denominations sont utilisees : pseudotumeur inflammatoire ; tumeur fibromyxoide pseudosarcomateuse ; fasciite nodulaire ; nodule a cellules fusiformes postoperatoire… Certains auteurs suggerent de grouper ces lesions sous le meme terme de « proliferations myofibroblastiques pseudosarcomateuses » et insistent sur la necessite de les distinguer de la tumeur myofibroblastique inflammatoire survenant chez l’enfant. Cette derniere, recemment reconnue comme une veritable tumeur, est dotee d’un potentiel malin capable de recidiver et de donner des metastases. Nous rapportons l’observation d’un jeune homme de 17 ans qui avait une masse vesicale dont l’examen histopathologique avait conclu a une proliferation myofibroblastique pseudosarcomateuse. Nous discutons a travers une revue de la litterature la relation de cette lesion avec la tumeur myofibroblastique inflammatoire et ses principaux diagnostics differentiels.

Resume Introduction L’amylose secondaire est une complication grave de la polyarthrite rhumatoide (PR). Elle est longtemps asymptomatique incitant a sa recherche systematique notamment dans les PR anciennes. Les objectifs de notre etude sont la determination de la prevalence de l’amylose a un stade infraclinique au cours de la PR par aspiration de la graisse abdominale (AGA) en comparaison avec la biopsie des glandes salivaires accessoires (BGSA) et la recherche des facteurs associes a cette amylose. Methodes Notre travail prospectif a porte sur 107 cas de PR (94 femmes et 13 hommes), inclus de facon consecutive pendant la periode allant de mars 2005 a janvier 2006. Nous avons precise pour chaque patient les caracteristiques cliniques, biologiques, radiologiques et therapeutiques. Tous nos patients ont eu une AGA et une BGSA ; la recherche de depots amyloides a ete effectuee par un microscope a lumiere polarisee apres coloration au rouge Congo. Resultats La prevalence de l’amylose infraclinique par AGA est de 21,5 %. Elle n’est que de 3,7 % par BGSA. Les facteurs associes a l’amylose infraclinque sont un delai diagnostique long ( p = 0,03), la presence de manifestations extra-articulaires ( p = 0,019), la proteinurie superieure a 0,3 g/24 heures ( p = 0,024) et la non-utilisation de methotrexate ( p = 0,046). Il n’y avait pas de correlation avec le depot amyloide en ce qui concerne l’âge, le sexe, la duree d’evolution de la PR, les deformations articulaires, le DAS28, le HAQ, le stade radiologique de Steinbrocker, le facteur rhumatoide, la vitesse de sedimentation, la CRP, la creatinine et l’hemoglobine. Conclusion La prevalence de l’amylose infraclinique par AGA au cours de PR est elevee (21,5 %). L’AGA est plus sensible que la BGSA pour la detection de cette amylose. Il convient de la rechercher par une technique simple, comme l’AGA notamment en cas de presence de facteurs de risque. Sa decouverte incite a une surveillance etroite et reguliere afin de depister et traiter precocement une amylose symptomatique.

Resume La surrenalectomie bilaterale comme option chirurgicale pour le traitement des patients avec hyperplasie congenitale des surrenales (HCS) secondaire au deficit en 21-hydroxylase a ete recemment proposee. Il y a cependant peu de donnees documentees concernant l’efficacite a long terme et les effets secondaires potentiels de ce traitement. Des patients presentant un deficit en 11β-hydroxylase (11βHD) sont egalement concernes par cette nouvelle approche therapeutique. Objectif Decrire notre experience de la surrenalectomie bilaterale comme traitement de l’hypertension grave chez un patient presentant un deficit en 11βHD et rapporter les resultats et le suivi a long terme (72 mois) apres la chirurgie. Patient et intervention Le cas rapporte est celui d’un patient de 22 ans, eleve en tant que garcon et presentant un pseudo-hermaphrodisme feminin secondaire a une insuffisance en 11βHD. Son hypertension est demeuree mal controlee par le traitement substitutif et antihypertenseur, l’exposant ainsi a des complications graves. La surrenalectomie bilaterale lui a ete proposee. Resultats L’intervention a ete suivie de la normalisation immediate de la pression arterielle. Au cours du suivi, aucune crise d’insuffisance surrenalienne n’a ete rapportee grâce a une bonne compliance therapeutique. Un taux moderement eleve de 11-deoxycortisol a persiste apres l’intervention ; il serait du a la presence de tissu ectopique. Conclusion La surrenalectomie bilaterale est une methode sure et efficace pour controler l’hypertension arterielle de l’HCS secondaire a un deficit en 11βHD. Le suivi clinique et biochimique a long terme des patients avec HCS traites par surrenalectomie bilaterale est necessaire.

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.

Resume Introduction Le carcinome parathyroidien (CPT) est une tumeur rare des parathyroides. Nous rapportons le cas d’un CPT revele par un erytheme noueux (EN). Presentation du cas Une femme de 53 ans etait admise pour exploration d’EN. La biologie objectivait la presence d’une hypercalcemie (3 mmol/l) et une parathormone a 184,89 ng/l. La cervicotomie avec etude histologique definitive concluait a un CPT. Les suites operatoires etaient simples. Il n’y a pas eu de recidive de l’EN avec recul actuel de huit mois. Discussion/Conclusion Le CPT est une entite rare pouvant mettre en jeu le pronostic vital. L’EN paraneoplasique reste une entite rare et son association a un CPT n’a pas ete rapportee auparavant. La recherche de neoplasies solides ou d’hemopathies chez un patient avec EN recidivant ou resistant au traitement conventionnel est systematique.

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.

Resume Introduction L’osteoblastome (OB) est une tumeur benigne osteoformatrice rare. Les localisations preferentielles sont l’arc posterieur des vertebres et les os longs. Nous rapportons une localisation inhabituelle d’un OB au niveau du processus mastoide de l’os temporal. Observation du cas Une jeune femme de 22 ans consultait pour une tumefaction douloureuse retro-auriculaire gauche. La tomodensitometrie avait conclu a une lesion agressive en montrant une lesion osteolytique au niveau de la mastoide gauche. L’examen histologique des fragments de curetage osseux concluait a un OB. Apres ablation de la tumeur l’evolution etait bonne sans recidives locales avec un recul de un an. Discussion/Conclusion A notre connaissance, ce cas serait le 14 e decrit dans la litterature ayant une localisation au niveau du processus mastoide de l’os temporal. Son diagnostic histologique peut etre difficile et l’osteosarcome constitue son principal diagnostic differentiel. Bien que considere comme une tumeur benigne, l’OB peut recidiver ou avoir un comportement agressif localement. Son traitement par resection complete, chaque fois que cela est possible, est preferable au curetage osseux classique.

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.

We report a case of pulmonary infarction in a 72-year-old woman who was hospitalised for hemoptysis, chest pain and weight and coin a lesion in the loss periphery of the left lower lobe. Camputed tomography of the chest demonstrated a sub pleural solitary nodule with spicular radiation. Video-assisted thoracoscopic surgery was performed to obtain a histological diagnosis. Thoracoscopic examination showed a lesion that evoked chronic abscess. Histological examination confirmed an ischemic infarction. This is the second case of pseudotumor due to pulmonary infarction that was diagnosed by video-assisted thoracoscopic resection.

Micropapillary bladder carcinoma is a recently described, rare variant of urothelial carcinoma reputed for its poor prognosis. The authors report the case of a 59-year-old man with invasive bladder tumour presenting with haematuria. Histological examination of resection chips revealed the typical histological features of high nuclear grade micropapillary carcinoma with invasion of the musculosa and the presence of numerous endolymphatic emboli. The authors discuss the clinicopathological and pathogenic features, treatment and clinical course of this tumour.

Inverted urothelial papilloma is a rare tumour particularly in the ureter. It is difficult to distinguish microscopically from low-grade urothelial carcinoma, inverted type. The authors report a new case of ureteric inverted papilloma in a 64-year-old man and discuss the histological diagnostic criteria, clinical features and prognosis of this tumour.

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.