Search

Central nervous system (CNS) tuberculosis is a postprimary form of tuberculosis with high mortality and morbidity rates, even with early diagnosis and treatment. Focal tuberculous cerebritis is extremely rare, typically occurring in patients without AIDS, and often associated with tuberculous meningitis. In endemic regions, it should be a primary consideration when encountering cerebral anomalies suggestive of granulomatous conditions. Its meningeal pseudo-tumor form poses a significant diagnostic challenge.We present the case of a 26-year-old man who arrived at the emergency room with cerebellar and pyramidal syndrome. Cerebral magnetic resonance imaging (MRI) revealed an expansive lesion in the right hemicerebellum with glove-finger edema and leptomeningeal thickening. Given the MRI findings and associated lung involvement, the diagnosis of tuberculosis was strongly suggested in our epidemiological context. Due to contraindications for lumbar puncture, high surgical risk, and strong clinical and radiological suspicion, antituberculous treatment was initiated in collaboration with neurologists and infectious disease specialists.The clinical and radiologic manifestations of CNS tuberculosis can mimic other infectious and noninfectious neurological conditions, as seen in our patient. Thus, familiarity with the imaging presentations of CNS tuberculosis among infectious disease specialists and radiologists is crucial for prompt and accurate diagnosis.

Cerebellar liponeurocytoma is a rare WHO grade II glioneuronal tumor, characterized by a benign course and a more favorable prognosis. In this paper, we report a 52-year-old man, hospitalized in emergency because of clinical signs of increased intracranial pressure, and gait disturbances. The MRI revealed a lateral well shaped solid lesion within the left cerebellar hemisphere, having a low signal intensity compared to the cerebrospinal fluid, and causing a triventicular hydrocephalus and tonsillar herniation. The patient underwent a direct approach of the tumor through a left suboccipital craniectomy. Total removal of the lesion was achieved, and the histological diagnosis was cerebellar liponeurocytoma. The tumor cell proliferation index was < 6 %, therefore, radiotherapy and chemotherapy were not implemented after surgery. After 5 years of close follow-up there were no clinical or radiological signs of recurrence.Our objective in reporting another case of this unusual tumor is to discuss clinical profile, radiologic and histologic features as well as treatment and prognosis of this rare posterior fossa tumor.

Cardiac echinococcosis, although rare, presents a range of clinical manifestations depending on the cyst's location within the heart. These manifestations can range from asymptomatic conditions to serious complications such as arrhythmias, valvular dysfunction, cardiac tamponade, heart failure, shock, or even death.This case report describes the unusual presentation of a young man with an intramyocardial hydatid cyst, which was incidentally discovered following an ischemic stroke. Diagnostic evaluation included echocardiography, as well as chest and abdominal angiography via computed tomography (angio-CT). Surgical intervention was undertaken, involving cystectomy and the removal of the cyst contents. The patient's postoperative recovery was uneventful and favorable.This report emphasizes important diagnostic and management considerations specific to cardiac hydatid cysts and includes a review of the relevant literature to provide context and depth to our findings.

Wilm's tumor (WT) accounted for the vast majority of renal tumors in children (92%). However, there are many atypical or rare forms of kidney cancer, and it is certainly useful to have a diagnostic orientation in imaging to differentiate between the different diagnoses, guiding that way the therapeutic management.We report the cases of 3 patients who were initially diagnosed with nephroblastoma on the basis of radiological data (via PACS search), underwent pre-operative chemotherapy and then nephrectomy, and whose anatomopathological evidence came back in favor of benign renal tumors.Nephroblastoma is the most common renal tumor in children, but other benign tumors should not be neglected, radiological signs that may point to this entity should be taken into account, so that neoadjuvant chemotherapy with its enfeebling side effects can be avoided.

Intussusception is a rare condition in adults, unlike in children, with a variety of etiologies. In most cases, it is secondary to tumors. acute intussusception on lipoma is very exceptional. We report a case of 68-year-old female patient, diagnosed with intestinal intussusception on lipoma.

Abstract Background In the current treatment landscape for non-small cell lung cancers, epidermal growth factor receptor-tyrosine kinase inhibitors have emerged as a well-established treatment option for patients with advanced or metastatic disease. This is particularly true for those with commonly occurring epidermal growth factor receptor mutations. However, the therapeutic efficacy of these agents for so-called rare epidermal growth factor receptor mutations, and in particular those characterized by a high degree of complexity, such as double mutations, remains a subject of clinical uncertainty. Case presentation In this context, we present the case of a 64-year-old man of Moroccan descent, a lifelong non-smoker, diagnosed with metastatic non-small cell lung cancer characterized by a complex epidermal growth factor receptor mutation encompassing L858R and S768I. The patient subsequently underwent afatinib-based treatment, showing notable clinical results. These included a remarkable overall survival of 51 months, with a median progression-free survival of more than 39 months. Conclusions This case report is a compelling testimony to the evolving therapeutic landscape of non-small cell lung cancers, providing valuable insight into the potential therapeutic efficacy of epidermal growth factor receptor-tyrosine kinase inhibitors in the realm of rare and complex epidermal growth factor receptor mutations.

Fibrosing mediastinitis, also known as sclerosing mediastinitis, is an uncommon condition marked by abnormal proliferation of fibrous tissue in the mediastinum. This condition may accrue either as an idiopathic condition or as a complication of an underlying disease process. Its pathogenesis remains unknown. However, most reported cases are incriminating abnormal immune-mediated hypersensitivity responses to Histoplasma infection. Other rare causes include tuberculosis, blastomycosis, and an idiopathic form that may be associated with other miscellaneous conditions. CT and MR imaging play a vital role in the diagnosis and management of this disease. We present a rare case of fibrosing mediastinitis as a late complication of tuberculosis in a 34-year-old man with a prior history of mediastinal tuberculosis, mimicking initially a neoplastic mediastinal process. We will describe this clinical case in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.

Malignant rhabdoid tumor is an uncommon pediatric tumor that often arises from the kidneys but can also develop in other soft tissues including the orbits, where it is known as atypical teratoid rhabdoid tumor. Orbital location is exceptional, with just a few reported cases. Imaging allows for an accurate diagnosis, but histological confirmation is required. The treatment is yet unclear but nearly often surgical, either with or without chemotherapy. In this report, we present a case of a neonate of 1-month-old with an orbital primary malignant rhabdoid tumor with synchronous cerebellar location. The patient was unable to undergo surgery, he had chemotherapy, and unfortunately died 1 week after following palliative treatment. We will illustrate this clinical experience and point out the importance of radiological imaging in the assessment of this uncommon condition.

Accessory breast tissue (supernumerary breast tissue) is due to the absence of regression of the primitive milk lines during embryonic life which extends from the axilla to the groin. It is mostly located in the axilla where it is often confused with the axillary extension of the breast, or any pathological process occurring in armpits. Ectopic mammary glands should not be misdiagnosed as it can potentially undergo the same pathological processes that occur in a normally located breast including benign or malignant breast tumors. We report the case of an intracystic papilloma arising from left axillary accessory breast tissue in a 63-year-old woman. The principal symptom was pain in a palpable left axillary mass without inflammatory signs. Subsequent imaging and histopathologic examination proved it to be a papillary tumor in ectopic breast tissue.

Post-traumatic testicular torsion is a rare condition, accounting for approximately 4%-8% of all reported cases of testicular torsion in the literature. Prompt clinical suspicion and intervention are crucial; as testicular torsion is considered a medical and surgical emergency that may lead to testicular necrosis. Ultrasound imaging plays an important role in assessing the integrity of the traumatized scrotum and facilitating early detection of associated testicular torsion. In this case report, we present a neglected post-traumatic testicular torsion in a 13-year-old child that led to orchiectomy.

Aortic coarctation is a congenital malformation that is relatively prevalent, occurring in approximately 5 out of every 1000 births. The narrowing typically happens at the aortic isthmus between the left subclavian artery and the arterial ligament. It is frequently associated with a bicuspid aortic valve.Generally, coarctation of the aorta is identified and treated during childhood or early adulthood. If left untreated, this condition can lead to a reduced life expectancy in individuals who have not received treatment.We present a case of a 52-year-old man who complained of chest pain, sputum, and hemoptysis persisting for approximately 2 years. Contrast-enhanced computed tomography (CT) scans revealed the presence of an anterior mediastinal mass, which was later confirmed to be a thymic carcinoma (on histological study). Additionally, an incidental finding of a thoracic aortic coarctation with a well-developed collateral circulation was observed.The discovery of aortic coarctation in adult patients as an incidental finding is rare and particularly uncommon in association with mediastinal or thoracic tumor pathology.Adult and elderly patients with uncorrected coarctation generally have a low survival rate, and the management strategies for such cases are controversial, especially when it is associated to other pathologies.Due to the complexity of therapeutic management and the limited literature available on postsurgical outcomes in these cases, making therapeutic decisions requires a multidisciplinary approach and personalized consideration for each individual case. This approach is necessary to evaluate the risk-benefit ratio and determine the most suitable therapeutic solution.

Mycotic aneurysms (MA) are a rare but severe complication of systemic infections, carrying a high risk of rupture, hemorrhage, sepsis, and potential multiple organ failure. Intracranial arteries are often affected and present a significant mortality risk due to cerebral bleeding and ischemic strokes. In this paper we describe the case of a 23-year-old female patient who presented with a sudden onset of right hemiparesis, followed by loss of consciousness. Cerebral imaging revealed multiple infarcts in both hemispheres and intracranial hemorrhage secondary to ruptured pseudoaneurysms. On transthoracic echocardiogram, she was found to have a left ventricular cardiac cyst with mobile vegetations potentially responsible for mycotic aneurysms and cerebral strokes. The patient underwent endovascular embolization for the mycotic aneurysms and cardiac surgery for the left ventricular cyst with satisfying clinical outcomes. Postsurgical analysis revealed the cyst to be of hydatid (Echinococcus) origin.

Adnexal torsion is a common gynecological emergency and a significant cause of acute pelvic pain in women. Hydrosalpinx-induced torsion of the adnexa is a rare situation and requires prompt and accurate management. Twenty-three years old nulliparous woman admitted in our structure for acute pelvic pain. The ultrasound revealed an enlarged right ovary with an adnexal cystic mass. We suspected the diagnosis of a right adnexal torsion due to cystic ovarian mass. Laparotomy revealed torsion of the right adnexa and a second large mass appearing to be a hydrosalpinx. Diagnosis of adnexal torsion is difficult and is based on a range of arguments obtained by anamnesis, clinical examination, ultrasonography and other investigations. Early diagnosis is important for preserving tubal and ovarian function, given the risk of ovarian necrosis in young women. Laparoscopy is the gold standard for diagnosing and treating adnexal torsion. The treatment can be conservative or radical, consisting of detorsion of the twisted adnexa, with or without adnexectomy.

Epigastric abdominal pain is a common indication for consultation. In the majority of cases, medical history, clinical examination and routine biological exams allow for an easy diagnosis. Sometimes the symptomatology is unusual, in which case it is essential to perform a complete clinical examination and to use various imaging techniques to search for eventual atypical causes. Membranous obstruction of inferior vena cava is a rare cause of such a phenomenon. We describe a Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava in a 66-year-old woman with no medical history as a rare cause of epigastric abdominal pain. We will describe this clinical experience in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.

Although it was first described over 100 years ago, lumbar puncture is still an important diagnostic tool for a variety of infectious and noninfectious neurologic conditions. With the widespread use of this common and relatively safe performed medical procedure, minor and major complications can occur even when standard infection control measures and good techniques are used, including post lumbar puncture headaches, infection, bleeding, cerebral herniation, radicular pain, and even pneumocephalus in extremely rare cases. We describe a previously unreported complication of lumbar puncture performed for the diagnosis of meningitis in a 33-year-old woman with no medical history causing pneumorrachis, tension pneumocephalus, and sacral meningocele infection leading to death. Lumbar puncture is a simple diagnostic procedure with few complications, but if the technique is incorrectly performed, or if it is accompanied by occult congenital malformations such as sacral anterior meningocele in our case, the consequences can be fatal.

Close follow-up of patients with liver cirrhosis has led to increased detection of hepatocellular carcinoma (HCC) at an early stage, especially with magnetic resonance imaging (MRI) innovations. We report the case of a 70-year-old man, with a recent history of liver cirrhosis due to chronic hepatitis C virus (HCV) complicated by hepatocellular carcinoma (HCC), and for whom trans-arterial chemoembolization (TACE) was planned, as the patient was assigned Child B7 at admission. Angiography performed during the first TACE cycle shows not only the “tumor blush” corresponding to previously detected HCC but also an additional small foci of HCC uptake seen within a large dysplastic nodule giving the appearance of “nodule-within-nodule.” Early detection of hepatocellular carcinoma improves prognosis. Hence, it is essential to be aware of all early aspects of HCC, including the nodule-within-nodule appearance on cross-sectional imaging, and also in angiography, as in this case.

Xanthogranulomatous pyelonephritis is a rare and aggressive form of chronic pyelonephritis, it can occur at all age groups but is more common in women than in men, supposedly relating to the increased incidence of urinary tract infections and chronic nephrolithiasis in woman. Computed tomography (CT) findings are very helpful in making the correct diagnosis, but the definitive diagnosis is still based on histology, as there are many differential diagnoses such as renal cell carcinoma and renal tuberculosis. The complications of this type of pyelonephritis are due to the involvement of adjacent organs. The most frequent ones are Psoas abscess, perinephric abscess, and sepsis. Nephrocutaneous and renocolic fistulas are less common. We report a case of a 61-year-old male, who presented to emergency for left-sided lumbar pain for whom radiological investigations confirmed a renocolic fistula complicating xanthogranulomatous pyelonephritis. The diagnosis of XGP was proven by histopathological examination of the nephrectomy specimen slides, but there was also association with an underlying malignant squamous differentiation consistent with urothelial carcinoma, which was not evident on CT. XGP is a rare variant of chronic pyelonephritis with known imaging features. The treatment of choice is nephrectomy and histopathological examination is required for final diagnosis, as there may be associated renal malignancy.

Background: Intestinal carcinoid tumors are well-differentiated neuroendocrine tumors that are capable of secreting bioactive hormones and/or amines; These tumors are uncommon but are the most common primary tumors of the small intestine. Case presentation: We report the case of an 80-year-old woman who presented with a long history (about 14 years ago) of atypical digestive symptoms such as vague abdominal pain, alternating diarrhea, and constipation, treated as functional colopathy without improvement, until the day when she presented with worsening pain that prompted her consultation. CT scan revealed typical manifestations of a carcinoid tumor associated with signs of subacute small bowel ischemia. Despite the surgery being considered a gold standard treatment, it was rejected due to the extent of tumor mesenteric involvement, therefore, the patient received only somatostatin treatment. Conclusion: Small bowel carcinoid tumors are rare, with typical imaging features based on cross-sectional imaging (CE CT/MRI). Intestinal ischemia is a well-known complication that can be a factor in mortality.

Intestinal malrotation is a congenital rotational anomaly that results of abnormal rotation of the gut, said to occur in 1 in 6000 live births. Common mesentery predisposes to volvulus of the midgut and internal hernias due to the left position of the cecum and appendix. The association of this anomaly with acute left appendicitis is rarely reported in the literature. Occurrence of acute appendicitis on common mesentery is a source of diagnosis difficulties, which may lead to a surgical management delay. We report a case of a 10-year-old boy, admitted for a left-sided iliac pain whose radiological investigations confirmed a left acute appendicitis associated with complete common mesentery. The child underwent laparoscopic surgery with simple post-operative follow-up.

Background: Giant cell tumors (GCTs) are locally aggressive but rarely malignant bone neoplasms that uncommonly involve the skull. In this report, we describe a tumor of the sphenoid sinus. Case presentation: A 51-year-old female was presented with headache, and bilateral decreased visual acuity, CT scan, and brain MRI revealed an infra-sellar enhancing tumor expanding to the sellar and supra-sellar region which proved to be a GCT. the patient had received 03 months of preoperative denosumab-based treatment and imaging follow-up showed regression in size and morphology modifications of tumor tissue. Conclusion: This is one of few reports to describe the appearance of sphenoid bone GCT, and the first report to highlight the effects of short-term denosumab treatment in GCTb in such a location.

Background: Carotid Web and focal carotid diaphragm are atypical fibromuscular dysplasia. The bilateral stroke due to this dysplasia is extremely rare. We will report a series of three young patients, admitted for a bilateral ischemic stroke caused by carotid bulb web and internal carotid diaphragm. Also, we will discuss their manifestations and treatment modalities. Case presentations: In our study, we will report a series of three North African patients, two females an one male, at the mean age of 37, admitted for an ischemic stroke caused by bilateral carotid bulb web and bilateral internal carotid diaphragm.All of our patients were young and didn't have a history of drug use. Conclusions: In our series, only end-vascular treatment was performed which was necessary to prevent any recurrence. Antiplatelet therapy was used in all cases to prevent any stroke during the follow-up.

Acute intestinal intussusception in adults is a rare condition, most often secondary to an organic lesion (tumor or inflammation), representing 1%-5% of intestinal obstructions. Pure colic intussusception on lipoma rectal causing bowel obstruction is an exceptional situation. A 60-year-old man presented to the emergency department for acute abdominal pain with marked abdominal distention and red rectal bleeding. A contrast-enhanced abdominal CT scan was performed, which revealed a recto-sigmoid intussusception on lipoma, causing mechanical intestinal obstruction. The patient underwent a partial reduction of the intussusception with partial sigmoid resection and end colostomy. Colonic lipomas of the recto-sigmoid region represent a very rare condition and a subsequent etiology for intussusception and bowel obstruction in adults. However, it should be considered in the differential diagnosis of such situations.

Hemimelic epiphyseal dysplasia HED also known as Trevor's disease is a rare pathology, characterized by a developmental disorder of an internal or external half of one or more epiphyses of a limb, mainly the lower limb, and/or of the short tarsal bones in children and young adolescents, with a male predominance. Its etiology remains unclear. Its clinical symptomatology is variable, ranging from asymptomatic involvement to orthopedic complications such as limb length inequality. As the clinic is non-specific, radiological assessment is the essential diagnostic tool for Trevor's disease, including standard radiography, MRI, CT, and possibly biopsy in some cases. The radio clinical signs make it possible to establish the diagnosis, even if it remains difficult because of the rarity of the disease and the presence of multiple differential diagnoses which are often better known such as osteochondroma and exostosis. After diagnostic confirmation, the therapeutic decision remains debated, ranging from simple observation to surgical excision. The prognosis of HED remains good, given the absence of the risk of malignant transformation. Post-therapeutic complications are dominated by recurrence or the appearance of secondary osteoarthritis. Objective: This clinical case challenges us to keep in mind the hemimelic epiphyseal dysplasia (HED) in front of a mass that originates at the level of the internal or external half of one or more epiphyses in children.

Sigmoid volvulus in pregnancy is a rare but potentially serious condition. It is related to a high risk of maternal and fetal morbidity and mortality. This is mainly due to delayed diagnosis and treatment. We report the case of a 38-year-old multiparous patient, pregnant at 32 weeks of gestation, who presented to the emergency room with intestinal obstruction evolving for 2 days. At the emergency room, radiological exploration revealed a sigmoid volvulus. Endoscopic decompression was unsuccessful. A midline laparotomy was performed urgently revealing a necrotic sigmoid colon. A sigmoidal resection with a colostomy (Hartmann's procedure) was performed. In utero, fetal death occurred intraoperatively. The patient was transferred to the intensive care unit. Induction of labor was performed on the 2nd postoperative day with vaginal delivery of a stillborn. Recovery was good with the restoration of intestinal continuity 4 months later. Through this case and a review of recent literature, we discuss the diagnostic and therapeutic difficulties of this rare entity and highlight the seriousness of delay in the management of this surgical emergency.

Background: We herein report the case of a patient with advanced lung adenocarcinoma who presented a heterogeneous distribution of EGFR mutation. Case report: A 74-year-old Moroccan male former smoker was diagnosed with advanced lung adenocarcinoma, harboring S768I exon 20 substitution mutation confirmed by Real Time PCR and Pyrosequencing, but not detected by direct sequencing despite 70% of tumor cells. The present report describes a case of minor histologic intratumoral heterogeneity with heterogeneous distribution of EGFR mutation. Conclusion: Both sensitivity and specificity of molecular methods can provide evidence of intratumoral heterogeneity, which may explain the mismatch between the validation of oncology biomarkers and predicting therapeutic response to targeted therapy.

Cystic hydatidosis is an endemic parasitic disease with usual localization in liver and lungs. Rarely it localizes in uncommon sites, the right ventricle being an exceptional localization.We present an extremely rare case of a young man with hydatid pulmonary embolism complicating right-ventricle hydatid cysts. Echocardiography, CT pulmonary angiogram and MR-angiography were performed for the diagnostic evaluation. Our patient did not undergo surgery. He was discharged on a regimen of albendazole, and is still being followed-up.Hydatid disease rarely presents with pulmonary embolism. It has uncharacteristic clinical features, requiring particular diagnosis and therapy.

Abstract Objective Mental imagery (MI) has long been used in learning in both fields of sports and arts. However, it is restrictively applied in surgical training according to the medical literature. Few studies have evaluated its’ feasibility and usefulness. The aim of this study is to assess the impact of mental imagery on surgical skills learning among novice’s surgeons. Material and methods In this pilot prospective randomized comparative study; we recruited 17 residents and interns of surgery education curriculum. They were all included in their first semester of the curricula. Two groups were randomly designed. Group (a) including “Mental Imagery” volunteers (n = 9) which benefited from a mental imagery rehearsal exercise prior to physical practice, while the control group (b) (n = 8) didn’t underwent any MI process prior to surgery practice. Each participant of both groups was invited to perform an intestinal hand-sewn anastomosis on bovine intestine. Each procedure was evaluated and analyzed according to 14 qualitative criteria while each criterion was scored 0, 1 or 2 respectively assigned to the gesture was not acquired, gesture was performed with effort, or mastered gesture. The final score is 28 for those who master all 14 gestures. A non-parametric statistical comparison between the both studied groups was performed. Results Both groups of surgery students demonstrated equivalent age, sex ratio, laterality, and surgical experience. The mean overall score is significantly higher in the MI group (a) (17.78; SD = 2.42) compared to the control group (b) (10.63, SD = 2.85). However, advanced analysis of individual assessment items showed significant statistical difference between both groups only in 6 out of 14 assessed items. Conclusion Indeed, mental imagery will not be able to substitute the traditional learning of surgery for novice surgeons; it is an important approach for improving the technical skills acquisition and shortening the physical learning.

Pilomatrixoma is a rare benign skin tumor originating from piliferous follicles, corresponding to a firm subcutaneous nodule requiring histology for diagnosis. Breast localization is considered to be very rare . Only few breast pilomatricomas have been reported, with imaging showing well defined nodules with microcalcifications, presenting as ACR BI-RADS 4 and 5, suspicious for a breast neoplasm . We report a case of pilomatrixoma of the left breast of a 33 year old woman, appearing as a firm, deep nodule in the lower outer quadrant.The lesion had mammographic and sonographic finding mimiking a breast cancer. Percutaneous biopsy was performed to confirm the histological diagnosis.

Cavernous hemangiomas are rare account representing 5%-13% of the intracranial vascular malformations and occur in approximately 0.5%-1% of the population. We report the case of 34-years-old woman, having a medical history of seizure, admitted for headache with binocular diplopia. The radiology investigation and operatory piece has shown an association of cavernous sinus hemangioma and frontal focal cortical dysplasia. This study highlights clinical, radiological and therapeutic features of this entity.

Thymolipoma is a rare benign neoplasm of the thymus containing both mature adipose tissue and thymic tissue. We report a case of a 34‐year‐οld man, presenting a mass of the anterior mediastinum, the radiology investigation and operatory piece diagnosed a thymolipoma.This study highlights the clinical diagnostic and therapeutic features as well as the evolutionary characteristics of this entity.

Objective Our prospective study aims to define the correlation of EGFR (epidermal growth factor receptor) mutations with major histological subtypes of lung adenocarcinoma from resected and non-resected specimens, according to the WHO 2015 classification, in Moroccan North East Population. Methods Epidermal growth factor receptor mutations of 150 primary lung adenocarcinoma were performed using Real-Time PCR or SANGER sequencing. SPSS 21 was used to assess the relationship between histological subtypes of lung adenocarcinoma and EGFR mutation status. Results 25 mutations were detected in the series of 150 lung adenocarcinomas, most of which were found in cases with papillary, acinar, patterns than without these patterns and more frequently occurred in the cases without solid pattern than with this pattern. A significant correlation was observed between EGFR mutation and acinar (P = 0,024), papillary pattern (P = 0,003) and, negative association with a solid pattern (P < 0,001). In females, EGFR mutations were significantly correlated with the acinar pattern (P = 0,02), whereas in males with the papillary pattern (P = 0,01). Association between the histologic component and exon 19 deletions and exon 21 mutations were also evaluated and, we found a significant correlation between the papillary major pattern with exon 19 mutations (P = 0,004) and, ex21 with the acinar component (P = 0,03). Conclusion An analysis of resected and non-resected lung ADC specimens in 150 Moroccan Northeast patients, revealed that acinar and papillary patterns may predict the presence of a mutation in the EGFR gene. While the solid major pattern may indicate a low mutation rate of the EGFR gene.

Primary tumor of the trachea is rare. Although most tumors in adults are malignant, various benign tumors might occur. However, pleomorphic adenoma of the trachea is extremely rare. So far, few cases have been reported in medical literature. We report a case of a 38-year-old man with 6 months history of dyspnea and wheezing; the asthma was the initial diagnosis formulated by his family doctor. However, the symptoms were not improved by asthma treatment. The patient was admitted to the emergency department for respiratory distress, and underwent nasal continuous positive airway pressure. Immediately, after an urgent chest computed tomography (CT) was done and revealed an obstructive tumor of the distal trachea which was homogeneous with a smooth and regular surface suggesting its benignity. The patient was operated urgently, the histological examination of the surgical specimen revealed pleomorphic adenoma. We present this case to inform colleagues that pleomorphic adenoma must be considered in the differential diagnosis of tracheal tumors, especially if we have an appearance on CT suggesting the benignity. Surgery is the treatment of choice of this tumor with the lowest recurrence probability.

Parkinson’s disease is a neurodegenerative disorder caused by loss of dopamine neurons in the substantia nigra pars compacta. Tremor, rigidity, and bradykinesia are the major symptoms of the disease. These motor impairments are often accompanied by affective and emotional dysfunctions which have been largely studied over the last decade. The aim of this study was to investigate emotional processing organization in the brain of patients with Parkinson’s disease and to explore whether there are differences between recognition of different types of emotions in Parkinson’s disease. We examined 18 patients with Parkinson’s disease (8 men, 10 women) with no history of neurological or psychiatric comorbidities. All these patients underwent identical brain blood oxygenation level-dependent functional magnetic resonance imaging for emotion evaluation. Blood oxygenation level-dependent functional magnetic resonance imaging results revealed that the occipito-temporal cortices, insula, orbitofrontal cortex, basal ganglia, and parietal cortex which are involved in emotion processing, were activated during the functional control. Additionally, positive emotions activate larger volumes of the same anatomical entities than neutral and negative emotions. Results also revealed that Parkinson’s disease associated with emotional disorders are increasingly recognized as disabling as classic motor symptoms. These findings help clinical physicians to recognize the emotional dysfunction of patients with Parkinson’s disease.

A 54-years-old woman suffered from a bilateral pelvic and lumbar pain. She had a systemic investigation shows a diffuse bone lesions. A biopsy of iliac bone was done and revealed sarcoidosis. Bony manifestations of sarcoidosis are rare and challenging to diagnose. Our report shows that MRI with diffusion weighted sequences is a simple and non invasive technique to evaluate bone infiltration. It helps to distinguish inflammatory disease from metastatic lesions and to guide the osseous biopsy. Moreover, fluorodeoxyglucose PET scan, are useful in establishing the extent of damage and measuring disease activity.

Abstract Considering SARS‐CoV‐2 as a major differential diagnosis of pneumocystis in HIV‐positive patients even if the lesions are typical.

Coeliac artery compression stenosis caused by the median arcuate ligament can lead to aneurysm formation in the pancreatico-duodenal arteries that can eventually result in a spontaneous rupture leading to retroperitoneal haemorrhage. In this case series, we describe the cases of three patients, all presenting with sudden epigastric pain, diagnosed as spontaneous haematoma, complicating a median arcuate ligament syndrome.

Hydatidosis is a zoonosis caused by Echinococcus granulosus Humans are accidentally contaminated by ingesting the parasiteÂ's eggs mainly released through the faeces from infected dogs. Hydatidosis affects the bone in 0.5 to 2% of cases, with 44% of these cases involving in the spine. Vertebral hydatidosis is rare and it represents the most frequent and most dangerous form of bone involvement. This manifestation is extremely delicate, difficult to correctly identify and manage. The authors report two cases of vertebral hydatidosis revealed by medullar compression and increasing lumbar-radicular pain and functional impotence of lower limbs. Imaging showed multicystic bony lesions in lumbar spine. The extension into the spinal canal and to the perivertebral soft tissue were involved in both cases. We present those two cases to highlight the role of radiological exploration for diagnosis especially with magnetic resonance imaging (MRI) and the importance of monitoring this dangerous pathology.

Le sarcome d´Ewing est l´une des principales tumeurs de l´enfant et du jeune adulte. Le sarcome d´Ewing extra-squelettique (SEE) est une tumeur maligne rare d'origine cellulaire mésenchymateuse de caractéristiques histologiques similaires à celles du sarcome d´Ewing osseux. Les sites de prédilections sont le tronc, les extrémités et le rétropéritoine. La tête et le cou sont des localisations rares. Les signes cliniques et radiologiques restent aspécifiques d´où l´intérêt de l´histologie pour le diagnostic. Nous rapportons le cas d´un nourrisson de 18 mois, qui présentait une masse parotidienne droite chez qui les examens d´imagerie objectivaient une masse tissulaire parotidienne et que l´histologie a conclu à un sarcome d´Ewing extra-squelettique. L´intérêt de ce dossier réside dans la localisation inhabituelle de la tumeur.

L'atrophie multisystématisée (AMS) est une affection neurodégénérative de l'adulte, d'évolution progressive et de pronostic sévère, affectant les voies pyramidales, extrapyramidales, cérébelleuses ainsi que le système nerveux autonome. Les critères diagnostiques sont essentiellement cliniques permettant le diagnostic d'AMS avec deux degrés de certitude: « possible » et « probable »; le caractère certain étant apporté par l'examen anatomopathologique. L´imagerie en particulier, l'IRM cérébrale peut montrer une atrophie putaminale, pontique et des pédoncules cérébelleux moyens. Nous rapportons le cas d´une femme, âgée de 56 ans, atteinte d´AMS dont l´évolution fut marquée par l´installation progressive d´un syndrome démentiel sévère. L´examen neuro-pathologique confirma le diagnostic d´AMS et révéla la présence de marqueurs histologiques de maladie d´Alzheimer. Cette association nosologique est extrêmement rare dans la littérature. Cette observation confirme que la survenue d´une démence sévère au cours de l´évolution d´une AMS doit faire rechercher une cause associée et souligne l´utilité d´une vérification anatomique en cas d´atypie clinique. L´intérêt de notre travail réside dans la rareté de la pathologie.

We report the case of a 23 year old female admitted for management of infection by the SARS-COV-2. The chest CT found a spontaneous pneumomediastinum that resorbed over 7 days with a good clinical outcome. We will discuss the mechanism underlying the occurrence of spontaneous pneumomediastinum during a COVID-19 pneumonia.

The trachea is an unusual site οf primary malignancy. Very few cases οf primary tracheal lymphοma with central airway οbstructiοn have been repοrted sο far. Cοmmοn cοmplaints are dyspnea and cοugh that cοuld mimic a partially refractοry asthma in sοme cases. In this article; we will present the case οf a 63-year-οld wοman diagnοsed with a tracheal lymphοma causing life-threatening airway οbstructiοn, this was cοnfirmed by brοnchοscοpy biοpsy and histοpathοlοgical exminatiοn.The mοrtality depends οn the prοgressiοn οf the disease, the οbstructiοn οf the airway. Hοwever, this entity has a gοοd prοgnοsis if diagnοsed immediately and treated with specific chemοtherapy.This case will shοw that the diagnοsis οf tracheal lymphοma shοuld be kept in mind within the differential diagnοsis οf central airway οbstructiοn. Keywords: Tracheal, Lymphοma, Cancer

A 39-year-old man presented with a productive cough, a history of chronic dyspnea and recurrent lower respiratory tract infections. Physical examination and laboratory tests were unremarkable. A chest X-ray (A) showed an enlarged tracheal diameter (white arrows), with multiple cysts in the lower lobes (red arrows). A computed tomography scan of the chest (B) showed the dilatation of both the trachea and the two main bronchi (white arrows) with multiple diverticulae (blue arrows). It also revealed bilateral cystic bronchiectasis involving both lower lung zones (red arrows). A possibility of Mounier-Kuhn syndrome (MKS) was considered. MKS is a rare condition characterized by recurrent lower respiratory tract infections and tracheobronchial dilation that is due to atrophy of the muscular and elastic tissues in the trachea and main bronchial wall. The patient underwent bronchoscopy which demonstrated tracheal dilation with diverticulae and enlargement of both main bronchi confirming the diagnosis of MKS.

Diffuse pulmonary ossification (DPO) is a rare condition that presents with metaplastic mature bone formation in the pulmonary parenchyma. DPO is usually associated with cardiovascular or respiratory disease. We report a case of 75-year-old man with chronic dyspnea, cough, asthenia and low sputum production. A chest x-ray revealed reticular pulmonary infiltrates on both sides. Computed tomography (CT) revealed peripheral, basilar predominant reticular opacities with areas of subpleural cystic change, compatible with fibrosis, fine branching calcifications within areas of linear reticulations were also visible in both mid and lower zones. Based on the clinical presentation and CT results, the patient was diagnosed with diffuse pulmonary ossification associated with idiopathic pulmonary fibrosis.Despite its rarity, the radiologist must know suggest the diagnosis of DPO especially in the presence of idiopathic pulmonary fibrosis associated with linear branched calcified densities in areas of fibrosis, avoiding a surgical biopsy that is not stripped of risk. Keywords: Ossification, Pulmonary, Fibrosis, Computed tomography

Il s'agit d'un jeune patient de 17 ans, sans facteurs de risques congénitaux ou héréditaires ni de notion de traumatisme ayant consulté pour une douleur lombaire avec troubles importants de la statique. A lexamen physique, les régions glutéales étaient aplaties et le bord supérieur de la première vertèbre sacrée était palpable dans le creux lombaire. Le patient présentait par ailleurs une hanche abaissée et des déhanchements à la marche. Une tomodensitométrie du rachis dorso-lombo-sacrée, demandée pour bilan étiologique, a mis en évidence un glissement complet vers l'vant du corps vertébral de L5, dont le plateau vertébral inferieur surplombait le bord antéro supérieur de la première vertèbre sacrée avec un aspect verticalisé du sacrum. Il sy associe une lyse isthmique gauche de L5 et des plages ostéo condensantes réactionnelles des berges osseuses. Une spondyloptose dégénérative par lyse isthmique a été porté comme diagnostic. En effet, elle constitue le grade V d'évolution d'une spondylolisthésis. En effet, la spondyloptose est une dislocation vertébrale complète de la cinquième vertèbre lombaire (L5) venant se placer en avant du sacrum (S1). Elle correspond au dernier stade d'un spondylolisthésis. La spondylolisthésis serait classée en cinq types: dysplasique, isthmique, dégénératif, traumatique et pathologique. Le traitement dune spondyloptose efficace est chirurgical chez les adultes, la thérapie par réduction reste une alternative chez les enfants. Notre patient a été mis sous traitement conservateur antalgique avec immobilisation simple, vu l'absence d'une issue chirurgicale.

L'atteinte du sinus caverneux au cours des leucémies aigues est rare et peut se faire par extension directe ou via une dissémination hématogène.L'aspect en imagerie n'est pas pathognomonique mais reste évocateur : le scanner montre une infiltration tissulaire du sinus caverneux, l'IRM est plus performante montrant un hypo signal T2 de cette infiltration, avec restriction de la diffusion et prise de contraste après injection du Gadolinium. Nous rapportons le cas d'un jeune homme, âgé de 22 ans, admis aux urgences dans un tableau d'HTIC évoluant depuis 10 jours avec diplopie horizontale. Une TDM cérébrale a objectivé un aspect élargi des 2 sinus caverneux qui sont spontanément hyperdense rehaussés de façon modérée après injection du produit de contraste. La NFS a montré une thrombopénie avec un taux de plaquettes à 33000/mm3, une hyperleucocytose à 16700/mm3, le taux d'hémoglobine était à 13.7g /l. Nous avons complété le bilan d'imagerie par une IRM cérébrale qui a montréune infiltration tissulairedes 2 sinus caverneux se présentant en hypo signal T2, avec restriction de la diffusion et prise de contraste homogène après injection du gadolinium. Une atteinte lymphomateuse a été évoquée sur cet aspect. 2 jours après le patient a présenté des hématomes à chaque point d'injection. Une NFS avec frottis ont montré un taux de plaquettes à 21 000/mm3 et des blastes à 25%, ensuite un myélogramme a été réalisé revenant en faveur d'une leucémie aigue lymphoblastique. L'évolution a été fatale par hémorragie digestive.

La maladie d'Hallervorden-Spatz est une affection autosomique récessive très rare. Elle débute essentiellement entre 5 et 12 ans, mais parfois même dans la première année de la vie. Des cas débutant chez l'adulte jeune ont été rarement rapportés. Sa symptomatologie comporte des signes extra-pyramidaux associant: rigidité, mouvements choréo-athétosiques, dystonie, dysarthrie, détérioration intellectuelle progressive et exceptionnellement une épilepsie myoclonique progressive. Environ la moitié des patients sont porteurs de mutations du gène PANK2, responsables d'une neuro-dégénerescence associée à la pantothénate kinase ou PKAN. La séméiologie IRM comporte des anomalies de signal bilatérales et symétriques du globuspallidus médial se traduisant sur la séquence pondérée en T2 par un aspect en éil de tigre avec une zone centrale en hypersignal en rapport les lésions neuro-axonales, entourée d'une zone périphérique en hyposignal net en rapport avec les dépôts de fer caractéristiques de la maladie. Cette maladie, pour laquelle il n'existe pas de traitement, conduit à la mort au cours de la deuxième ou troisième décennie de la vie. Nous rapportons le cas d'un jeune homme, âgé de 22 ans, présentant depuis 1 an une dysarthrie associée à une myoclonie et une dystonie des membres inférieurs, chez qui les explorations paracliniques ont été négatives (bilan du cuivre, métabolisme et transport du fer), mais l'IRM cérébrale a objectivé un hypersignal T2 des globipallidi entouré d'un hyposiganl net. Le diagnostic de la maladie d'Hallervorden-spatz a été retenu. Le patient a été mis sous traitement symptomatique à base de myorelaxants (Baclofène) et de valproate de sodium.

L'anévrysme de la veine de Galien est une affection congénitale rare, représentant moins de 1 % des malformations artério-veineuses intracrâniennes. Il résulte de l'absence de différenciation en système artério-veineux mature, entre 7 et 12 SA, d'une veine embryonnaire primitive, médiane qui draine les plexus choroïdes primitifs. La majorité des cas de malformation anévrysmale de la veine de Galien sont diagnostiqués en périodes anténatale, néonatale ou post- natale, le diagnostic à l'âge adulte est exceptionnel. Le tableau cliniqueà tout âge peut inclure: insuffisance cardiaque, retard psychomoteur, hydrocéphalie et crises d'épilepsie. Le traitement de référence est l'embolisation réalisée à quelques mois de vie mais le pronostic reste redoutable. Nous rapportons le cas d'un homme, âgé de 38 ans, admis aux urgences dans un tableau d'état de mal épileptique avec un syndrome méningé à l'examen clinique. Une TDM cérébrale a objectivé unemasse de la région pinéale, présentant des calcifications périphériques, rehaussé intensément après injection du produit de contraste en rapport avec une volumineuse dilatation anévrysmale de la grande veine de Galien. L'IRM cérébrale a montré cet anévrysme qui mesure 50 x 50 x 40 mm, associé à une dilatation du sinus droit et de multiples dérivations veineuses péri-anévrysmales avec épaississement et rehaussement dure-mérien régulier et diffus en rapport avec une méningite bactérienne confirmée par le bilan biologique. Vu qu'il n'y avait pas de signes d'hypertension intracrânienne ni d'hydrocéphalie, le patient a reçu un traitement médical de sa méningite associé à un traitement antiépileptique avec une bonne évolution clinique.

Le lipome intraosseux est une tumeur bénigne rare représentant 0,1% de l'ensemble des tumeurs squelettiques. Au membre inférieur, sa localisation au calcanéum est retrouvée dans 15% des cas. Son étiopathogénie demeure imprécise et reste partagée entre origine tumorale bénigne et post-traumatique. Elle touche avec légère prédominance féminine, le sujet de la quatrième ou cinquième décade. La clinique dénuée de toute spécificité, se limite à des douleurs mécaniques de l'arrière pied; en revanche l'imagerie et particulièrement l'IRM permet de poser avec quasi-certitude le diagnostic en objectivant une tumeur de signal typiquement graisseux. Le traitement reste partagé entre l'abstention et la chirurgie avec curetage lésionnel et greffe spongieuse dans les formes douloureuses ou comportant un risque de fracture pathologique. Nous rapportons le cas d'une jeune femme, âgée de 24 ans, présentant des douleurs de type mécanique de l'arrière pied gauche, résistantes aux traitements antalgiques et chez qui une IRM a objectivé une tumeur du calcanéum se présentant en hyper signal avec liseré périphérique d'ostéosclérose en hyposignal sur les séquences T1 et T2 et perdant son signal sur la séquence de suppression de graisse, témoignant de son caractère graisseux. Nous avons retenu le diagnostic de lipome et vue que la douleur a été intense avec retentissement sur l'activité physique, la patiente a bénéficié d'un traitement chirurgical, consistant en un curetage du produit lipomateux avec greffe spongieuse.