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The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.

Introduction: La proportion de tunisiens diabétiques a atteint 15,5% des personnes âgées de plus de 15 ans en 2016. L'objectif de ce travail a été d'analyser la prise en charge des diabétiques dans des structures de santé contrastées. Méthodes: La méthodologie mixte (quantitative et qualitative), àdevis séquentiel explicatif, a été utilisée. Une étude transversale a été menée dans un Centre de Santé de Base (CSB) àNabeul et àl'Institut National de Nutrition et de Technologies Alimentaires (INNTA). Afin d'expliquer les résultats quantitatifs, des entretiens semi-directifs ont été réalisés auprès de différents professionnels et patients des deux centres. Résultats: L'étude quantitative auprès de 100 patients au CSB et 96 àl'INNTA a montré que l'équilibre glycémique n'a été atteint que dans moins de 30% des patients dans les deux structures de soins. Quoique l'examen clinique était meilleur au CSB, la réalisation de l'ECG, le dosage de l'HbA1c et du HDL-Ch étaient loins de l'optimal. L'étude qualitative a dégagé certaines hypothèses pour expliquer ces écarts: la pénurie de traitements essentiels et de tests biologiques de base ont diminué l'attractivité des CSB, aggravant ainsi l'encombrement dans les hôpitaux. Par ailleurs, L'encombrement des consultations et le manque de communication étaient les deux raisons majeures de l'insatisfaction des patients et des prestataires de soins. Conclusion: Notre étude défend l'apport de la première ligne des soins dans le management du diabète. Cependant, Il s'avère urgent de renforcer la première ligne par un plateau technique approprié, un système d'information pour le suivi de la qualité des soins et un appui des capacités des médecins généralistes en éducation, information et communication.

To assess the birthweight of neonates conceived after fresh and frozen embryo transfers (FET) and, if different, to investigate whether estradiol levels during the late follicular phase were associated with the observed difference.Singleton pregnancies from fresh and FET transfers between January 1990 and December 2013 were compared retrospectively. A total of 2885 singleton pregnancies after fresh embryo transfer and 746 after FET were analyzed. Obstetric and neonatal outcomes were compared between fresh and FET cycles.The singletons born after FET were found to have a significantly higher birth weight (3313 g), compared to those born after fresh embryo transfer (3143 g); p .001. The main predictor of this difference was found to be estradiol levels at the end of the follicular phase. The difference in birthweight was inversely correlated to estradiol levels considering all cycles together but also considering fresh and frozen cycles separately.Our study demonstrates a link between high estradiol levels and low birth weight of singletons after IVF both in fresh and frozen-thawed embryo transfer cycles. It provides additional support to the involvement of hyperestrogenemia in the process of implantation and on the subsequent fetal development.

Objective: To find the genetic etiology of premature ovarian insufficiency (POI) in a patient with primary amenorrhea and hypergonadotropic hypogonadism. Design: Case report. Setting: University hospital. Patient(s): A Belgian woman aged 32 years with POI at the age of 17, her parents, and her sister whose POI was diagnosed at age 29. Intervention(s): Analysis of a panel of 31 genes implicated in POI (POIGP) using next-generation sequencing (NGS), Sanger sequencing, and in vitro functional study. Main Outcome Measure(s): Gene variants, family mutational segregation, and in vitro functional impact of the mutant proteins. Result(s): The analysis of the gene panel using NGS identified the presence of two novel follicle-stimulating hormone receptor (FSHR) missense mutations at a compound heterozygous state in the affected patient: c.646 G>A, p.Gly216Arg, and c.1313C>T, p.Thr438Ile. Sanger sequencing showed the presence of each mutation at heterozygous state in the patient's parents and at heterozygous compound state in the affected sister. Both substituted amino acids (Gly216 and Thr438) were conserved in FSHR of several vertebrate species as well as in other glycoproteins receptors (TSHR and LHCGHR), suggesting a potentially important role in glycoprotein receptor function. An in vitro functional study showed similar results for both variants with more than 90% reduction of their cell surface expression and a 55% reduction of their FSH-induced cyclic adenosine 3′:5′ monophosphate (cAMP) production compared with the wild-type FSHR. Conclusion(s): The analysis of a gene panel of 31 genes implicated in POI allowed us to identify two novel partially inactivating mutations of FSHR that are likely responsible for the POI phenotype of the proband and of her affected sister., SCOPUS: ar.j, info:eu-repo/semantics/published

Objective: This study assesses the role of fine-needle aspiration cytology (FNAC) in the diagnosis of tuberculous lymphadenitis (TL) in comparison with histology and bacteriology findings. Study Design: We undertook a descriptive retrospective study of 937 FNAC specimens from 851 patients with cervical lymph nodes. The FNAC findings were then compared to histopathology and bacteriology. Results: Of the 937 aspirates, the cytopathological diagnoses consisted of 426 (55.9%) TL, 185 (24.3%) reactive lymphoid hyperplasia, 18 (2.3%) suppurative inflammation, 78 (10.2%) malignant metastatic tumor, and 54 (7%) lymphoma. Of the 426 TL cases, 171 were diagnosed by FNAC combined with bacteriological examination. In this group, 22 cases were found to be positive on Ziehl-Neelsen stain and 16 by culture. A histopathology report was available for 62 cases. Compared to histopathology, the overall diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in the diagnosis of cervical TL were, respectively, 96.77, 100, 100, and 96.67%. When comparing bacteriology to histopathology, these values were 97.44, 100, 100, and 91.67%. Conclusion: Our study shows that FNAC is a sensitive and specific tool for the diagnosis of cervical TL.

Objectives To report the first case of Sex cord-stromal tumour with rhadomyosarcomatous contingent heterologous in a 7-year-old girl with history of xeroderma pigmentosum (XP). Methods We report the clinical data, imaging investigations, and outcome data of a 7-year-old girl treated for XP. We used the fourth edition of the WHO classification of tumors of female reproductive organs for pathological study. Results A 7-year-old girl with history of XP was presented with a large 12x7 cm ovarian tumor associated with ascites and general deterioration. Radiological investigations confirm the presence of the tumor which was unilateral and does not appear to infiltrate the surrounding tissues The patient was operated by laparotomy The diagnosis of sex cord-stromal tumour with rhadomyosarcomatous contingent heterologous could not be made in the frozen section. The final examination confirms the diagnosis. Chemotherapy was scheduled but the patient died a few weeks after the surgery. Conclusions Ovarian tumors are exceptionally associated with XP. They present a particular histological and evolutionary profile. Their pathogenesis and their management is not codified due to the rarity of this entity.

L'ostéochondrome est la tumeur osseuse bénigne la plus fréquente. Elle touche habituellement les métaphyses des os longs, particulièrement autour du genou et de l'humérus proximal. Il touche très rarement la symphyse pubienne avec fréquemment une symptomatologie atypique. Nous rapportons le cas d'un ostéochondrome de la symphyse pubienne empiétant sur la branche osseuse ilio-pubienne chez un homme de 35 ans, de découverte fortuite. Les explorations radiologiques, l'examen macroscopique et histologique confirment le diagnostic ainsi que l'absence de signe de malignité.

Gastric diverticula are the most uncommon form of gastrointestinal diverticula. They can either be of true or false type with different pathogenesis. They may be very challenging to diagnose as symptoms are nonspecific and imaging can simulate a malignant lesion. We report an unusual case of pre-pyloric diverticulum in a 69-year-old man, leading to severe gastric obstruction with a poor general condition. As subsequent endoscopy and imaging were alarming and couldn't exclude malignancy, the patient underwent an antrectomy. The final diagnosis was made on pathological examination. We discuss, through this case, the clinical and pathological features of gastric diverticula with an emphasis on the pathogenesis of this rare entity and the risk of a malignant transformation.

A 38-year-old man, with no history of malignancy, was found to have a 2 cm jugular lymph node, for which a lymph node tuberculosis was suspected. The specimen revealed a cystic structure lined by mature keratinizing squamous epithelium with a prominent granular cell layer consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. This is the first case report of a rapidly enlarging squamous inclusion cyst in a jugular lymph node. Our case demonstrates the diagnostic challenges related to a squamous inclusion cyst in cervical lymph node and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations., Oncology; Pathology; Health Sciences; Intranodal squamous inclusion cyst; Ectopic tissues; lymph node; Differential diagnosis; tuberculosis

Background Head and neck masses are a common presentation in daily practice and can be challenging to both clinicians and cytopathologists. Fine needle aspiration cytology (FNAC) is a widely used method for the diagnosis of head and neck masses. The aim of the study was to assess our institutional experience of the accuracy of FNAC in the diagnosis of head and neck masses. Methods A total of 1262 FNACs were conducted from January 2013 to December 2016 and subdivided into benign and malignant categories. The thyroid and salivary glands FNACs were classified according to the Bethesda System for Reporting Thyroid cytopathology and to the Milan System for Reporting Salivary Gland Cytopathology respectively. The measures of diagnostic accuracy of FNAC were determined taking histology as a gold standard. Results A total of 7 false negative (FN) and 6 false positive (FP) FNACs were identified. Overall sensitivity and specificity of FNAC for a malignant diagnosis were 92% and 94.4%, respectively. Accuracy of FNACs of head and neck masses was 93.5% for all sites. The salivary gland group had the highest rate of FN (2.8%). All FP were reported in the thyroid group. These cases were cytologically classified suspicious for malignancy (n = 3) and papillary carcinoma (n = 3) and proved to be lymphocytic thyroiditis on final histology. Among the most common locations, cytology of lymph nodes provided the best sensitivity (98.2%). Salivary glands as well as lymph nodes had the best specificity (100%). Conclusion FNAC of head and neck masses has a high accuracy allowing a correct therapeutic management. However, this accuracy depends on the anatomic location of the mass.

Mortality for colorectal cancer is mainly due to liver metastases, surgical resection remains the curative treatment and use of neoadjuvant therapy improves resectability of metastases. Pathological response is an important prognostic factor.To evaluate tumor response by Tumor regression grade (TRG) according Rubbia-Brandt et al and correlation with survival. To establish chemotherapy-related liver injury.Thrity-eight patients resected for colorectal cancer liver metastases after neoadjuvant chemotherapy were enrolled in this study. Tumor regression grade (TRG) according to Gradding Rubbia-Brandt et al. was evaluated.Sex ratio was 1.5 with an average age of was 55 years. Twenty-five patients were in stage IV (65.7% of patients with synchronous liver metastases). Overall survival was 62% at 12 months, 42% at 24 months and 21% at 36 months. Thirty-four patients (89.5%) received Oxaliplatin and nine (23.7%) irinotecan. Twenty patients (52.6%) had no histologic response (TRG 4 and 5), nine (23.7%) had a major response (TRG 1 and 2) and nine had a partial response (TRG3). Survival was more important with major pathologic response than with partial response or no response. No statistically significant relation was found between survival and the different types of response. Chemotherapy-related liver injury were present in 21 patients (55.2%). Conclusions: Scoring system with three grades are currently recommanded to evaluate pathological response and new histopathological data are proposed. Larger studies are required to validate these items and their utility for therapeutic decisions.

Traditionally, a gallbladder removed for presumed benign disease is sent for histopathological examination, but this practice has been the subject of controversy.The aim of this study was to assess the usefulness of routine histopathological examination of cholecystectomy specimens and its impact on the management of patients.The histopathological reports of 1960 patients who underwent cholecystectomy from January 2011 to November 2016 were retrospectively reviewed. Results : There were 519 men and 1441 women (sex-ratio M/F = 0,36) aged between 8 and 96 years (mean = 51,23 years). All patients underwent cholecystectomy (either open or laparoscopic). Histological examination of the surgical specimens showed chronic cholecystitis (n = 1319) (67,29%), acute cholecystitis (n = 117) (5,96%), cholestrolosis (n = 255) (13%), follicular cholecystitis (n = 230) (11,73%), xanthogranulomatous cholecystitis (n = 6) (0,30%), cholesterol polyps (n = 5) (0,255), tubular adenoma (n = 3) (0,15%), mucocele (n = 2) (0,10%), pancreatic heterotopia (n = 2 ) (0,10%), hyperplastic Luschka ducts (n = 2) (0,10%), adenomyoma (n = 2) (0,10%), porcelain calcification (n = 2) (0,10%) and biliary-type adenocarcinoma (n = 9) (0,46%). In 9 cases (0,46%), the gallbladder was histologically normal.Our study shows that the incidence of pre-malignant and malignant lesions of the gallbladder is very low. We therefore recommend selective histopathological examination of cholecystectomy specimens with abnormal macroscopic findings.

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.

Abdominal pregnancy is rare accounting only for 1% of all ectopic pregnancies. Broad ligament pregnancy occurs in about 1/300 ectopic pregnancies. Preoperative diagnosis of a broad ligament pregnan...

The present study illustrates an analysis of histological changes; cadmium (Cd), copper (Cu) and zinc (Zn) accumulation; and metallothionein (MT) levels in normal and deformed Mediterranean killifish, Aphanius fasciatus (Pisces, Cyprinodontidae), collected from unpolluted (S1) and polluted areas (S2) in the Gulf of Gabes in Tunisia. Metal determination in water and sediment showed that the concentrations were significantly higher (p < 0.0001) in S2 compared to S1. Deformed fish showed a significantly higher accumulation of Cd, Cu, and Zn and high levels of MTs in their tissues compared to normal ones. Histopathological investigations revealed greater changes in gills, kidney, liver, and bone tissues of fish from the polluted area than those recorded in fish from the reference area. In comparison to normal fish of the polluted area (S2), tissue alterations were more developed in deformed specimens of this site. A possible relationship between metallic pollution, incidence of spinal deformities, and histological changes in A. fasciatus in the polluted site was discussed.

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.

Objectif Evaluer la tolerance de la pression positive continue (PPC) et son influence sur l’observance. Methodes Etude prospective incluant 83 patients ayant un syndrome d’apnees du sommeil severe diagnostiques en 2010 et ayant accepte le traitement par PPC. La duree de suivi etait de 4 ans. Resultats L’âge moyen etait de 52 ans. Les effets secondaires (EI) etaient notes chez 75,9 % des patients. Les EI nasaux etaient les plus frequents. Ils etaient representes par la secheresse nasale (43,3 %) et l’obstruction nasale (25,3 %). Le traitement a consiste en l’ajout d’un humidificateur (15,6 %), la prescription de corticoides nasaux (9,6 %), de vasoconstricteurs (1,2 %) et le traitement chirurgical (1,2 %). Chez nos patients, des complications liees au masque etaient representees par l’usure du masque (26,5 %), les fuites autour du masque (20,5 %), les lesions cutanees (3,6 %), les lesions oculaires (3,6 %) et la claustrophobie (1,2 %). Le traitement etait un changement du masque dans 42 % des cas, une adaptation de la methode du port du masque dans 12 % et une reparation de l’appareil de PPC dans 3,6 %. L’observance therapeutique etait associee a des EI moindres notamment la sensation de suffocation ( p p = 0,029) et les fuites par le masque ( p = 0,007). Conclusion Malgre les nombreux progres technologiques realises en termes d’etancheite, de confort et d’ergonomie des masques, la majorite des patients traites par PPC developpent des effets indesirables lies a l’interface. Un traitement adequat permet d’ameliorer l’observance et la tolerance de la PPC.

Here, we report the first autochthonous cases of infections caused by bla NDM-5 New Delhi metallo-β-lactamase-producing Escherichia coli strains recovered from urine and blood specimens of three patients from Algeria between January 2012 and February 2013. The three isolates belong to sequence type 2659 and they coexpress bla CTX-M-15 with the bla TEM-1 and bla aadA2 genes.

La notion de conversion est omniprésente dans les études socio-historiques consacrées au soufisme, courant mystique de l’islam, dans le monde occidental. A tel point que le terme figure en permanence dans nos propres notes de recherche sur la genèse des mouvements soufis en Europe occidentale au début du XXe siècle. Pourtant, sa mention dans les archives des groupes étudiés est rare et parfois volontairement décriée ou dissimulée. Comment expliquer le caractère systématique de son usage ? Loin de n’être qu’une erreur d’approche, l’analyse de phénomènes de conversions peut au contraire affiner la manière de concevoir la notion d’entre-deux qui met en rapport deux univers : l’islam et l’Occident.

Gilthead sea bream larvae (Sparus aurata) aged 47 days post hatching (dph) (11.6-12.8 mg in wet weight) were exposed to several sublethal concentrations of Cd2+ (0.1, 5 and 10 mg/L) during 6 days in order to investigate the effects of this heavy metal on the expression of selected genes involved in detoxification (metallothionein-mt, glutathione peroxidase 1-gpx1), stress response (heat shock protein 70-hsp70, tumour necrosis factor alpha-tnf alpha) and ossification (osteocalcin-oc) processes. For this purpose, specimens of 47 dph were exposed first for 72 h from 0.1 to 20 mg/L of Cd2+ in order to evaluate the median lethal concentration (LC50) for this metal, which was determined at 15.32 mg/L. Considering the results regarding the relative transcript levels of gpx1 and hsp70, Cd2+ at any of the tested levels (0.1, 5 and 10 mg/L) did not induce oxidative stress in gilthead sea bream larvae, whereas relative transcript levels of mt were increased at 5 and 10 mg/L of Cd2+ probably to detoxify this metal excess. Relative transcript levels of tnf alpha were not level dependent and were down-regulated in larvae exposed to 5 and 10 mg/L of Cd2+. At those concentrations, transcript levels of oc were down-regulated suggesting a disruption in bone mineralization. Results from this study provided insights in some molecular mechanisms underlying Cd2+-induced toxicity in fish at early stages of development. This is the first study to show that cadmium contamination can depress oc expression in teleosts.

The aim of this study was to assess the effect of high temperature on cadmium (Cd)-induced skeletal deformities in juvenile Mosquitofish, Gambusia affinis. For this purpose, 188 juveniles (1 day old) were equally divided into the control group, which was maintained in Cd-free water at 24 degrees C, and three treated groups exposed either to Cd (0.4 mg/l as Cd Cl(2)) at 24 degrees C, to high temperature (32 degrees C), or to Cd at 32 degrees C for 30 days. The results showed that Cd exposure at 24 degrees C significantly increased the Cd accumulation (P < 0.0001) in the whole tissues of juveniles as well as the incidence of skeletal deformities (P < 0.01) compared with control animals. Exposure to high temperature also led to a significant increase in the incidence of skeletal deformities (P < 0.01) with respect to the control group. Interestingly, our results showed that the combined exposure to Cd and high temperature led to a more significant increase in Cd accumulation and in the frequency of spinal deformities than exposure to Cd or high temperature alone. These results confirm that temperature increases Cd toxicity and needs to be taken into account for the accurate prediction and assessment of Cd-induced spinal deformities in fish.