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Primary adenosquamous carcinoma of the stomach is extremely rare and accounts for less than 1% of gastric malignancies. It is particularly aggressive and generally results in a poorer outcome than other carcinomas. Microscopically, it consists of a mixture of two distinct components: adenocarcinoma and squarnous cell carcinoma. We present two cases of gastric adenosquamous carcinoma in two female patients, aged 63 and 70, and discuss the clinical and pathological characteristics of this unusual tumour. [ABSTRACT FROM AUTHOR]

Abstract: Visceral leishmaniasis due to Leishmania infuntum is endemic in Tunisia. The incidence in adult patients has increased in recent years; but most of these patients are not HIV positive as in other Mediterranean countries where all the cases are associated with HIV. We present the case of a woman with symptoms suggestive of leishmaniasis but whose bone marrow was sterile and whose serological tests for Leishmania spp. were negative. For this patient, the parasite was only detected in a routine duodenal biopsy. There are few reports of visceral leishmaniasis cases diagnosed by duodenal biopsy and almost all patients were HIV positive in that case. Thus it seems interesting to perform a duodenal biopsy in case of a difficult diagnostic even in the absence of gastrointestinal symptoms and/or HIV infection. [Copyright &y& Elsevier]

La carcinome endométrioïde primitif de la trompe est exceptionnel. Il n'a été rapporté que trois fois dans la littérature. Sa survenue sur endométriose tubaire doit répondre, comme pour l'ovaire, à des critères histologiques stricts, établis par Sampson et Scott en 1953. Nous en rapportons une observation concernant une patiente âgée de 45 ans, ayant subi une hystérectomie totale avec annexectomie bilatérale pour des ménométrorragies associées à des léiomyomes utérins résistants au traitement médical. La découverte du carcinome endométrioïde intra-épithélial primitif de la trompe gauche développé sur une endométriose tubo-ovarienne bilatérale était fortunite lors de l'examen histologique. Notre observation semble être unique dans le sens où elle met en évidence une filiation certaine entre les lésions d'endométriose tubaire et le carcinome endométrioïde contigu, à l'inverse du seul cas similaire rapporté dans la littérature où le continuum entre ces deux lésions n'a pas été objectivée. [ABSTRACT FROM AUTHOR]

Background: Orbital hydatidosis is rare, accounting for only 1% of all hydatid cysts. Herein we report a case and review the sparse literature., Methods: Case report and review of pertinent literature., Results: A 74-year-old farmer presented with progressive proptosis and loss of vision of the left eye. Evaluation revealed a hydatid cyst of the orbit. Orbital hydatidosis is usually unilateral and unaccompanied by cysts elsewhere in the body. Most affected are children and young adults. Although there is no gender predominance, orbital hydatidosis may affect the left eye preferentially. Onset is usually insidious over several months. Serologic testing is unreliable, and imaging by computed tomography or magnetic resonance imaging is now standard. Surgical resection is curative, but albendazole must be administered postoperatively if there is spillage intraoperatively., Conclusions: Hydatid cysts should be included in the differential diagnosis of unilateral proptosis in patients from regions where echinococcosis is endemic.

Objective: To analyze epidemiological characteristics, clinical symptoms, radiological aspects, treatment and outcome of central nervous system hydatidosis and compare our results with those reported in literature., Patients and Methods: In our retrospective study, we reviewed 39 cases of primary central nervous system hydatid cysts operated on in our hospital between 1998 and 2007., Results: There were 20 male and 19 female patients (sex-ratio M/F=1.05) between 2 and 68 years of age (mean=26.5 years). Thirteen of the patients were children (33.3%) with a mean age of 6.8 years and 26 were adults (66.7%) with a mean age of 36.3 years. The location of hydatid cysts was intracranial in 27 cases (69.2%) and spinal in 12 cases (30.8%). Headache and motor deficits were the predominant symptoms in patients with intracranial hydatidosis whereas back pain and spinal cord compression syndrome were the most frequent clinical presentations in patients with spinal hydatidosis. All patients underwent surgical resection of the cyst. Pathologic findings were consistent with hydatid cyst in all cases. During the follow-up period which ranged between 12 months and 5 years, 12 patients had recurrence (30.7%). Only one patient with intracranial hydatid cyst died postoperatively due to anaphylactic shock., Conclusion: Despite all the advances in imaging techniques and therapeutic methods, central nervous system hydatidosis remains difficult to cure and patient outcomes are not satisfactory especially in case of spinal involvement due to the high incidence of recurrence., (2009 Elsevier B.V. All rights reserved.)

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

Aim of Study: The authors wanted to analyze the epidemiological features of extrapulmonary hydatid cysts and compare their results with those reported in literature., Methods: Two hundred and sixty-five cases of extrapulmonary hydatid cysts collected from 1990 to 2007 were retrospectively studied., Results: One hundred and one male and 164 female patients (sex ratio M/F=0.61 mean age 38.7 years) were included. In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%)., Conclusion: Contrary to published data, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which ranks 3rd. Such unusual results may be due to a selection bias.

Extraventricular neurocytomas are rare neuronal tumours that have been included in the 2007 WHO classification as a variant of central neurocytoma. They arise outside the ventricles, usually within the cerebral hemisphere,s but also in other regions throughout the neuraxis. The morphological overlap of these tumours with oligodendroglioma often poses diagnostic difficulty. Herein, a case of extraventricular neurocytoma in a 4-year-old girl is reported that mimicked histologically oligodendroglioma. The authors describe the clinicopathological features of this rare entity with special emphasis on differential diagnosis.

Background: Intracranial germ cell tumors are rarely seen and typically localize in the pineal or suprasellar region. The largest category of germ cell tumors is dysgerminoma., Aim: to describe clinicopathological features and immunohistochemical profile of dysgerminomas., Case Report: We report three cases of central nervous system dysgerminomas. There were two young women and a man who were 6, 11 and 23-year-old. They presented with symptoms of insipidus diabetes (n=3) with association to visual field defects in the third case. Radiological findings showed a supra seller lesion in two cases. Double localization in the pineal and suprasellar regions was seen in the third case. Histologic examination and immunohistochemical study of surgical specimen were consistent with primary central nervous system dysgerminoma.

Background: Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body., Aim: The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature., Methods: A retrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken., Results: There were 101 male and 164 female patients (sex ratio M/F = 0.61) ranging in age from 2 to 84 years (mean age = 38.7). In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%). The other less frequent sites included the peritoneum (n = 9), heart (n = 9), bone (n = 6), adrenal gland (n = 4), epiploon (n = 4), orbit (n = 4), ovary (n = 3), prostate (n = 2), bladder (n = 2), breast (n = 2), Douglas' cul-de-sac (n = 2), diaphragm (n = 1), testis (n = 1), broad ligament (n = 1), mediastinum (n = 1), nasal cavity (n = 1), soft tissue (n = 1), abdominal wall (n = 1), parotid gland (n = 1), psoas muscle (n = 1), synovia (n = 1), thymus (n = 1) et le pancreas (n = 1)., Conclusion: In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank.

Background: Subependymomas are rare, slow-growing, ependymal neoplasms that commonly occur in the fourth or lateral ventricles., Objective and Design: A retrospective study of 6 histologically proven subependymomas was undertaken to analyse their clinicopathological characteristics., Results: There were five male and one female patients ranging in age from 11 to 50 years (mean 35.8 years). All patients were symptomatic at diagnosis. The most common clinical presentations included headache (n=6) and vomiting (n=3). Tumours were located in the lateral ventricle in five cases and in the fourth ventricle in one case. Magnetic resonance imaging detected obstructive hydrocephalus in all cases. Five patients underwent gross total resection and one patient had subtotal excision of the tumour. Histologically, all tumours were characterised by clustering of isomorphic cells arranged against a fibrillary background. Focal cystic degeneration was seen in 5 tumours. During the follow-up period, which ranged between 2 months and 10 years, all patients were symptom-free with no evidence of recurrence.

Primary amylosis is rarely located in bone, exceptionally in the spine. The radiographic presentation is polymorphous. Magnetic resonance imaging is currently the best imaging technique. Spinal amyloidosis can exceptionally lead to cord compression requiring rapid surgical release.

Aim of Study: To assess the value of intraoperative frozen-section diagnosis in thyroid surgery and determine its limitations., Methods: This retrospective study examined the results of 1534 frozen sections of thyroid specimens analyzed over the 11-year period from 1995 through 2005 and their correlations with the final histological examination. Deferred responses were not taken into account for statistical calculations., Results: In our series, frozen-section diagnosis was concordant with subsequent histopathological examination in 92% of cases, discordant in 3%, and deferred in 5%. The global specificity of frozen section analysis for all histological subtypes was 99.8% and its sensitivity 67%. Its sensitivity for thyroid cancer was lower in follicular (42%) and papillary carcinoma (64%) than medullary (100%), anaplastic (100%), secondary (100%), mixed (100%), and insular carcinomas (86%)., Conclusion: In our series, as in the literature, most of the discordances between frozen-section and definitive diagnosis were associated with microfollicular lesions, which explain the low sensitivity of 67%. Our results demonstrate the reliability of intraoperative frozen-section analysis in thyroid surgery. Collaboration between pathologists, radiologists, and clinicians should be emphasized.

Most mesenchymal tumours of the gastrointestinal tract are now referred to as gastrointestinal stromal tumours (GISTs). These tumours typically express c-kit (CD117) and CD34; 30-50% are (often focally) positive for alpha-smooth muscle actin, and all are negative for desmin and S100 protein. Recently, mutations in exon 11 of the c-kit gene have been identified as a molecular genetic marker for the subset of GISTs. In this report, we describe a mesenchymal tumour removed from the pelvic cavity of a 34-year-old man. The tumour was strongly attached to the external wall of the urinary bladder. The neoplasm grossly resembled a leiomyoma, and was histologically composed of sheets of spindle cells with a dense collagenous background. The mitotic activity was low (less then 1 per 50 high-power fields). Immunohistochemically, tumour cells were negative for alpha-smooth muscle actin and desmin and positive for CD117 and CD34. This case illustrates that tumours which are phenotypically and genotypically similar to GISTs may present in sites other than the tubular gastrointestinal tract.

Cutaneous gamma-delta T-cell lymphoma (CGD-TCL) is an uncommon lymphoma composed of a clonal proliferation of mature activated gamma-delta T-cells expressing a cytotoxic phenotype. Malignant lymphoma is rarely associated with Behcet's disease, as only 12 cases have been reported in the literature, including a case of cutaneous T-cell lymphoma. In this report, the authors present a new case of CGD-TCL emerging in the course of Behcet's disease in a 40-year-old man. Diagnosis of CGD-TCL was established based on the combination of clinical, histological, immunophenotypical and molecular findings. Through a review of the current literature, the authors analyse the unique clinicopathological, molecular and immunohistochemical features of this rare cutaneous lymphoma.