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We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL.In this prospective study, 42 untreated Senegalese patients with CLL were enrolled. The diagnosis was established, based on the peripheral blood count and flow cytometry using the Matutes score. Cytogenetic aberrations, assessed by fluorescence in situ hybridization (FISH), were available for 30 patients, while the immunoglobulin heavy chain genes (IGVH) mutation status was performed by next-generation sequencing (NGS) in 24 patients. The SC percentage was determined in the blood smear, as previously described. Statistical analyses were executed using the GraphPad Prism 8.The mean age was 63 years (48 - 85) and the male: female sex ratio was 4.66. A low SC (30%) percentage was correlated with Binet stage B/C (p = 0.0009), CD38 expression (p = 0.039), unmutated IGVH status (p = 0.0009) and presence of cytogenetic abnormalities (for del 13q, p = 0.0012, while for other cytogenetic aberrations, p = 0.016). An inverse correlation was found between the SC percentage and the absolute lymphocyte count (r = -0.51) and patients with higher percentage of SCs had a prolonged survival. However, there was no correlation between the SC percentage and age (p = 0.41) or gender (median, 19% for males vs. 20% for females; p = 0.76).When less than 30%, the SC was associated with a poor prognosis in CLL. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

Introduction: Biermer’s disease is an autoimmune cause of anemia characterized by malabsorption of vitamin B12. It is often accompanied by other autoimmune pathologies. The objective was to study its profile in patients followed in the internal medicine department of the Abass Ndao hospital center. Methods: This was a retrospective and descriptive study of patients followed for Biermer’s disease from January 1, 2014 to December 31, 2019 (5 years). Results: 57 cases were collected, an incidence of 5.4 in the internal medicine department. The sex ratio was 0.58, an average age of 56.4 years. The circumstances of discovery were dominated by anemic syndrome (87.7%), dermatological (33.3%), digestive (29.8%), neurological (20%) pathologies. The specific signs to Biermer’s disease were digestive manifestations in 70.2% (including 30% Hunter’s glossitis), neurological manifestations in 36.8% (including 17.5% paresthesias), palmoplantar melanoderma in 68.4%. The mean hemoglobin level was 6.8 g/dL with a mean corpuscular volume of 110.7 fl. The myelogram reported megaloblastosis in 100% of the cases. The mean serum vitamin B12 level was 100 pg/ml. The anti-intrinsic factor antibody assay performed in 50 patients was positive in all cases. Upper digestive endoscopy showed an aspect of fundic atrophy in 69%. Histology showed intestinal metaplasia in 2 patients. An autoimmune disease was associated in 21% of cases. All patients had received treatment with vitamin B12 (51 patients took intramuscularly and 6 oral treatment). The course was favorable in all cases with a complete correction of the anemia. Conclusion: Biermer’s disease is a reality in Senegal. Its clinical and biological characteristics can be superimposed on the data in the literature. His prognosis under treatment is good whatever the route of administration of vitamin B12.

Introduction and background Hemophagocytic lymphohistiocytosis (HLH) is a condition caused by inappropriate stimulation of macrophage cells with hemophagocytosis. This paper aims to describe its diagnostic specifics and etiology and seeks to identify the factors that affect its prognosis in the black African adult population. Methods A retrospective multicentre study was carried out in three medical units in Senegal: Department of Internal Medicine at Pikine Teaching Hospital, and Department of Internal Medicine and Department of Nephrology at Aristide Le Dantec Teaching Hospital; the study covered the period from January 1, 2012 to March 30, 2015. This study included patients aged 18 years and older with a Hemophagocytosis Score (HScore) of ≥202 (with probabilities of acquired HLH of >90%). The data was obtained through medical records. Results In total, 26 patient files were included. The average age of the patients was 41 years, with a male-to-female ratio of 2.25:1. Fever and cytopenia were frequent. Other clinical signs included peripheral lymphadenopathy (69.2%), hepatomegaly (53.8%), splenomegaly (34.6%), neurological disorders (34.5%), and respiratory disorders (15.3%). Thrombocytosis was noted in three cases. Renal involvement was present in eight patients, with one case of collapsing glomerulopathy. The bone marrow aspirate revealed myelodysplasia in 12 patients. The dominant etiologies of HLH were hematological malignancies and infections. The mortality rate of HLH was 73%. Male gender and non-etiological targeted therapy were significantly associated with mortality. However, the age of

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04); and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

Key Clinical Message RDD (Rosai Dorfman disease) is a rare and benign histiocytic proliferative disorder of unknown etiology. FNAC (Fine-needle aspiration cytology) is a useful and reliable tool for the diagnosis of RDD, and as such, biopsy is avoidable.

The lymph node is the revelation mode of several pathology. In tropical area, their etiology are dominated by tuberculosis and hemopathy. Some etiology such as histiocytosis are rarely mentioned. We report two cases of Rosai-Dorfman-Destombes disease. The first observation concerned a patient of 45 years without pathological antecedent, who had a inguinal and cervical tumoral lymph nodes. This evolved in a feverish poor general condition. Infection research was negative. Morphological explorations found deep lymph nodes. The excision biopsy examination concluded to Rosai-Dorfman-Destombes disease. The second observation concerned a patient of 40 years without pathological antecedent, who had a chronic non-inflammatory left supra-collarbone lymph node, associated with poor general condition and fever. X-ray showed mediastinal lymph nodes and ultra-sonography showed mesenteric lymph nodes, and latero-aortic lymph nodes. The examination of the excision biopsy was for Rosai Dorfman Destombes disease. The difficulty of diagnosis in our regions based on technical tray lack and our patients financial limits. Also this disease is rarely mentioned first. This is often the source of considerable diagnostic delay noted in our two patients and therefore the initiation of an untimely anti-tuberculosis treatment.

Kimura’s disease, common pathology in the East, responsible of chronic neck swelling is rarely reported in sub-Saharan Africa. We reported a case which was observed in the internal medicine department of Aristide Le Dantec hospital in Dakar. This was a young 15-year-old, with no particular disease history, who had recurrent non-inflammatory swelling next to the left zygomatic bone associated with itching. Biology revealed an inflammatory syndrom, eosinophilia and increased serum IgE. The histological examination of the mass biopsy concluded to Kimura disease. The corticosteroid has reduced the size of the mass within a few weeks of treatment. Kimura’s disease is unknown in our regions. His painless character and chronic evolution delay the time of diagnosis. This case proves the reality of this disease, which must find a place in the diagnosis approach of cervical swelling.

Introduction Les thérapeutiques innovantes du myélome multiple sont peu accessibles en Afrique subsaharienne. Le but de cette étude est de décrire les particularités diagnostiques et évolutives observées dans notre pratique de prise en charge des myélomateux. Méthodes Une étude rétrospective (2005 - 2016) descriptive à visée analytique, mené à l’hôpital Le Dantec (Sénégal) a concerné les myélomateux inclus selon les critères de l’International Myeloma Working Group (2003, 2014). Résultats Ont été colligés 136 dossiers (69 hommes, 67 femmes) de patients d’âge moyen 59 ans ± 10,1 ans et qui ont un âge inférieur à 65 ans dans 69,1% des cas. Les signes révélateurs ont été des douleurs osseuses (96,3%), une insuffisance rénale (36,8%), une infection (23,5%), une fracture pathologique (17,6%), une compression médullaire (16,9%), et une hypercalcémie maligne (16,2%). L’isotype a été IgG dans 61,3% des cas et Kappa dans 65% des cas. Les malades ont été classés stade III (59,4%) et I-II (40,6%) de l’index staging system. Sous traitement conventionnel (Méphalan-Prédnisone: 67,6%, innovant: 5,9%), la survie médiane a été de 20 mois (1-78 mois). La survie est meilleure, en l’absence de complications neurologiques, infectieuses et au score I-II de l’Index Staging System. Conclusion Dans notre étude, le myélome multiple est fréquemment diagnostiqué avant 65 ans, au stade de forte masse tumorale. La survie globale peut être améliorée par un dépistage précoce et un accès aux thérapeutiques adéquates.

Introduction: Pernicious anemia is an autoimmune disease. It is characterized by the presence of an autoimmune atrophic gastritis and various autoantibodies that lead to a vitamin B12 deficiency responsible for a macrocytic anemia. It is frequently associated with other specific or non-organ- specific autoimmune diseases. We report six patients with pernicious anemia associated with other autoimmune diseases. Patients and Results: There were six patients (4 females/2 males), mean age of 39.67 years. In all cases it was found macrocytic anemia. The average Hb was 6.08 g/dl and the average MGV: 110.67 fl. Bone marrow aspiration was performed in all patients. Megaloblastosis compatible with a lack of vitamin B12 or folic acid was constant. Determination of serum vitamin B12 was low in all cases while folic acid levels were within standards. Immuno- logically it was found in all patients, a positivity of anti-intrinsic factor antibody and/or anti- parietal cells antibody at rates up to 67 times over normal ranges. Pernicious anemia was associated with autoimmune thyroid dysfunction in 4 patients. It was two cases of Hashimoto thyroiditis at hypothyroidic phase (high TSHus, thyreoperoxydase anti-antibody positive (over 10 N) in both cases and Graves’ disease in the two other cases. Pernicious anemia was associated with a syndrome of primary antiphospholipid antibody in a case. Furthermore pernicious anemia was found in a patient autoimmune type 1 diabetes with strongly positive anti -GAD antibodies and rheumatoid arthritis by retaining it in the diagnosis of multiple autoimmune syndrome. Conclusion: These cases illustrate the existence of the association of pernicious anemia with other autoimmune diseases in our context. This should encourage practitioners to seek hided autoimmune diseases when they consider the diagnosis of pernicious anemia.

Introduction: Natural killer/T-cell lymphoma, nasal type is a distinct entity, rarely reported in sub-Saharan Africans. Although the skin is the second most common involved site after the nasal cavity, very few cases of primary cutaneous extranodal natural killer/T-cell lymphoma (PC-ENK/T-NT) have been reported so far. Their clinical features reported in the literature are variable.Case report: We report a case of a 48-year-old man with a PC-ENK/T-NT presenting as a multinodular and ulcerated tumor of 9 cm in diameter on his left leg, mimicking a large B-cell lymphoma, leg type at the onset and only developed nasal and lymph node involvement at a later stage.Conclusion: PC-ENK/T-NT in our case is remarkable by its presentation simulating a B-cell lymphoma of leg type.

hma.2012.0666 Auteur(s) : Fatou Samba Diago Ndiaye1 kinepierre1@yahoo.fr, Madoky Magatte Diop2, Abdoulaye Pouye1, Seynabou Fall1, Atoumane Faye1, Therese Moreira-Diop1 1 Clinique Medicale 1, CHU Aristide-Le-Dantec, Dakar, Senegal 2 Universite de Thies, UFR des Sciences de la Sante, Cite Malick SY, Thies, Senegal Tires a part : F. Samba Ndiaye La mastocytose systemique (MS) est une maladie caracterisee par l’infiltration des tissus par des mastocytes neoplasiques provenant de [...]

Auteur(s) : Fatou Samba Diago Ndiaye, Seynabou Fall, Yakham Leye, Inoussa Bako, Awa O Toure, Abdoulaye Pouye, El Hadj Niang, Therese Moreira-Diop Service de medecine internet, CHU Le Dantec, Dakar, Senegal La rupture spontanee ou pathologique de rate survient en dehors de tout traumatisme. Depuis sa premiere description faite en 1861 par Rokitanski, quelques series ont ete publiees jusque-la [1]. Elle constitue rarement une circonstance de decouverte de la leucemie [...]

Introduction: Imatinibmesylate has significantly improved the survival of patients with chronic myeloid leukemia, with less toxicity than previous chemotherapy. Methods: We describe the profile of hematological side effects or not Imatinib mesylate; through a retrospective study of 1 June 2006 to 31 June 2011, led to the unity of Hematology Le Dantec in Dakar (Senegal) in patients with chronic myeloid leukemia, imatinibmesylate treated. Chemotoxicity was classified according to WHO grades. Results: A total of 55 patients followed; 24 (43.6%) had non-hematological side effects of grade 1-2, dominated by diffuse depigmentation (15 cases), followed by musculoskeletal symptoms (10 cases), digestive (6 cases), infection (4 cases) and secondary amenorrhea (1 case). Cytopenias observed in 34 patients, were more grade 1-2 (58.2%). Conclusion: The side effects are common, rarely severe as reported in the literature. Our study is unique in the high frequency of diffuse depigmentation unlike western series.

INTRODUCTION: The non-Hodgkin's lymphoma is the monoclonal proliferation of B and T lymphocyte cells, responsible for the development of tumors in lymphoid organs. The objective of this study was to describe the prognostic factors for NHL and their impact in the care of patients METHODOLOGY: This is a descriptive retrospective study on patients hospitalized files Medical Clinic I of the Aristide Le Dantec Hospital from January 2005 to December 2009. Were included in the study, patients for whom diagnosis of non-Hodgkin lymphoma was made on the basis of the results of histological and / or immuno-phenotypic examination of the biopsy specimen. Prognostic factors were studied and classified according to the prognostic scores in order to assess their impact on patient survival. Data analysis was done thanks to the IPSS software and the significance level was set at p ≤ 5%. RESULTS: NHL 44 cases represented on all patients hospitalized for haematological malignancies during this period, a prevalence of 45.4%. We have noted an increase in the incidence of NHL 2005 to 2009. The sex ratio was 2.6 / 1 and the mean age was 46.77 years [17-78 years]. Among the general symptoms, fever and weight loss were in the forefront (61.4% of patients) and lymph nodes were the most frequent physical signs (75%) followed by splenomegaly (47.7%). anemia was found in 72.7% of cases, leukocytosis in 45.5% of cases and thrombocytopenia in 47.7% of patients. Thirty-seven point four percent of patients were classified stage IV Ann Arbor at diagnosis. The presence of general signs scalability B was observed in 70% of patients. Regarding the prognostic factors, the International Prognostic Index (IPI) was studied in 43.2% of patients (n = 19) patients showed that 16% (n = 3) were IPI 1; 37% (n = 7) had an intermediate risk (IPI 3 and 4) and the remaining 10% were high risk (IPI 4). The IPI adjusted for age (aaIPI), noted a correlation of the IPI with certain age groups (50 and 60 years, p = 0.00001, 60 and 70, p = 0.00001). All patients were classified LLC Binet stage C and FLIPI was low (1-2). Evolution were marked by a 100% survival for low-risk patients (with a statistically significant correlation between survival and IPI 1: p

Purpose: The unfortunate association between myasthenia gravis and Graves’ disease is not widely appreciated. It would be consistent with a genetic predisposition for autoimmune disease. The frequency of

The incidence of CLL in Africa is not known for several reasons, among them the difficulty to access the diagnosis since there is only clinical features and cytology which are available in several countries in francophone Africa, especially in Senegal. The WHO criteria which have been published since 2001 from the first revised WHO classification of tumours of haematopoitic and lymphoid tissues cannot be applied since there is no facility for immunophenotyping and cytogenetic. Moreover, no research in place can be set up without any precise diagnosis. In this study, we have developed the flow cytometry technique in the laboratory of Immunology in CHU Le Dantec in Dakar to obtain the immunophenotype looking at the expression of Kappa/lambda light chains, CD19, CD22, CD20, FMC7, CD5, CD10, CD23, CD38. Peripheral blood smears were fixed according to the technique for FISH to detect the following cytogenetic abnormalities: trisomy12, deletion 13q14, deletion 11q22-23, deletion 17p. RNA to test by qRT-PCR the expression of microRNA mir15a, mir16-1, mir181a, mir181b, and mir 34a and 34b was obtained from peripheral blood lymphocytes. Twelve cases of CCL aged ranging from 50 to 80 year old were characterized at clinical level according to the Binet’s system: 1 stage A, 5 stage B, 6 stages C. In most of cases (9 cases) hyperlymphocytosis of small lymphocytes with clumped chromatin and scanty cytoplasm was very high (122.000 to 336 000/mm3). The “Matutes” score obtained by immunophenotyping was 5 or 4 for 11 patients in favor of typical CLL. The expression of CD38 which is a marker of unfavorable prognosis is positive in 9 patients. Nine patients had cytogenetic abnormalities: 3 trisomy 12, 6 del 13q14, 2 del 11q22-23, 1 del17p. Four patients had two simultaneous cytogenetic abnormalities (tri 12, tri 13 ; del13q14, del11q22-23 ; del13q24, del17p ; del13q24, tri12). The analysis of mi-RNA showed high expression of mir15a and mir 16-1 and low value of mir181a and mir 181b which were described in aggressive CLL ; however the expression of mir 34a and mir34b was also high. This study shows the aggressiveness of CLL in Senegal, probably due to the delay of the diagnosis. We have also demonstrated the possibility to set up immunophenotype and the possibility of a precise diagnosis of lymphoproliferative disorder in place, in western Africa and the series will be extended. Moreover we have also demonstrated the possibility to construct translational research project from samples characterized in the University Hospital in Dakar gathering the cases from different sanitary structures in the country. Such experiment would be a model for epidemiologic, clinico-biologic and translational research studies in order to set up in the country the capacity building for diagnosis and research. Disclosures: No relevant conflicts of interest to declare.