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Background: The activation of Fas/Fas ligand (FasL) and DR4-DR5/tumor necrosis factor-related-apoptosis-inducing ligand (TRAIL) pathways in cancer cells triggers apoptosis. The objective of this study was to investigate the prognostic value of soluble FasL (sFasL) and soluble (sTRAIL) in the serum of patients with bladder cancer. Methods: The sFasL and sTRAIL levels in the sera of patients with bladder cancer or healthy donors were determined using the enzyme-linked immunosorbent assay. Micro-culture tetrazolium viability assay and Western blot were used to analyze cell cytotoxicity and death receptors protein expression respectively. Results: Whether no difference in sTRAIL levels was seen between patients and controls, the level of sFasL was higher in patients than that in healthy donors. According to, sFasL level was the highest in the serum of patients with superficial stage or low- and medium-grade cancer. Moreover, sFasL in patients with superficial noninvasive bladder tumors or low- and medium-grade cancers was higher than that in patients with invasive carcinomas and high-grade cancers. Patients with high levels of sFasL survive longer than those with low levels, probably related to the cytotoxic potential of FasL preserved in its soluble form. Conclusion: The data suggest that monitoring the level of sFasL and its cytotoxic activity could be a prognostic marker in the follow-up of patients with bladder cancer.

We studied epidermal growth factor receptor (EGFR) expression profile with the aim of an individualized therapy for patients with non-small cell lung cancer (NSCLC) from whom tumor materials are not sufficient for molecular investigations. Using immunohistochemistry, we found a markedly increased EGFR expression with significant difference in term of intensity and distribution from normal mucosa to primary tumors (p < 0.05). Furthermore, patients with EGFR positive tumors had significantly shorter survival than those with EGFR negative tumors (p = 0.0001). Thus, EGFR over-expression is a valuable prognostic marker to predict poor outcome in Tunisian patients with NSCLC.

Many classification systems are currently used for histological evaluation of the severity of chronic viral hepatitis, including the Ishak and Metavir scores, but there is not a consensus classification. The objective of this work was to study the intra and inter-observers agreement of these two scores in the histopathological analysis of liver biopsies in patients with chronic viral hepatitis B or C. Fifty nine patients were included in the study, 26 had chronic hepatitis C and 33 had chronic hepatitis B. To investigate the inter-observers agreement, the liver biopsies were analyzed separately by two pathologists without prior consensus reading. The two pathologists conducted then a consensual reading before reviewing all cases independently. Cohen's kappa coefficient was calculated and in case of asymmetry Spearman's rho coefficient. Before the consensus reading, the agreement was moderate for the analysis of histological activity with both scores (Metavir: kappa=0.41, Ishak: rho=0.58). For the analysis of fibrosis, the agreement was good with both scores (Metavir: kappa=0.61, Ishak: rho=0.86). The consensus reading has improved the reproducibility of the activity that has become good with both scores (Metavir: kappa=0.77, Ishak: rho=0.76). For fibrosis improvement was observed with the Ishak score which agreement became excellent (kappa=0.81). In conclusion, we recommend in routine practice, a combined score: Metavir for activity and Ishak for fibrosis and to make a double reading for each biopsy.

International audience; Various studies in western countries found Akt amplification to be a frequent event in human cancers, including bladder, but the correlation with clinicopathological features is controversial. Such studies have not been reported in African populations, including Tunisians. The purpose of this study was to assess expression of the phosphorylated/activated forms of Akt in tumors from Tunisian patients with bladder cancer and to correlate its expression with pathological and clinical parameters of the disease. The study included 72 patients of whom 34 were diagnosed as low- to medium-grade and 35 as high-grade; 30 were muscle stage and 39 non-muscle stage. Primary tumors from these patients, normal adjacent tissues, or bladder cancer cell-lines were analyzed for Ser473 phosphorylated Akt expression by Western blot. Seventy-two percent of primary tumors from patients with bladder cancer had increased levels of p-Akt. The p-Akt levels in patients with high-grade bladder cancer were significantly elevated compared to patients with low- or medium-grade bladder cancer. In invasive carcinoma, the p-Akt level was significantly higher than in superficial non-invasive bladder tumors. Concerning the influence of tobacco on Akt activation, no significant differences of p-Akt expression were found between non-smoker and smoker patients. Altogether, our results suggest that Akt activation can provide useful prognostic information and that tobacco represents a serious risk factor for recurrence in a cohort of Tunisian patients.

International audience; Background: The aim of this study was to investigate the clinical significance of three immune cell-related transcription factors, T-bet, GATA-3 and Bcl-6 in bladder cancer in Tunisian patients.Methods: Expression of T-bet, GATA-3 and Bcl-6 genes was assessed using RT-qPCR in 65 bladder cancers from patients: 32 being diagnosed as low-and medium-grade, 31 as high-grade, 25 as muscle invasive stage and 39 as non-muscle invasive stage. Gene expression was statistically correlated according to the grade, the stage, tobacco consumption, the BCG response and disease severity.Results: T-bet levels in patients with high-grade bladder cancer were significantly elevated compared to patients with low-or medium-grade bladder cancer (p = 0.005). In invasive carcinoma (T2-T4), the T-bet levels were significantly higher than in superficial non-invasive bladder tumors (Tis, Ta, and T1) (p = 0.02). However, T-bet is predictive of the response to BCG. Its expression is high in good responders to BCG (p = 0.02). In contrast, the expression of GATA-3 and Bcl-6 in non-invasive carcinoma (p = 0.008 and p = 0.0003) and in patients with low-and medium-grade cancers (p = 0.001 and p < 0.0001) is significantly higher than in invasive bladder tumors and in patients with high-grade bladder carcinoma, respectively. In addition, heavy smokers, whose tumors express low levels of GATA-3 and Bcl-6, are poor responders to BCG (p = 0.01 and p = 0.03). Finally, better patient survival correlated with GATA-3 (p = 0.04) and Bcl-6 (p = 0.04) but not T-bet expression.Conclusions: Our results suggest that T-bet expression in bladder tumors could be a positive prognostic indicator of BCG therapy, even if high levels are found in high-grade and stage of the disease. However, GATA-3 and Bcl-6 expression could be considered as predictive factors for good patient survival.

Background Pemphigus is a severe and life-threatening autoimmune bullous dermatosis. Objective We have analysed parameters that may influence prognosis of pemphigus (P). Methods It was a retrospective study (2002–2010), with pemphigus considered as severe if body surface involvement ≥30%. Disease control and relapse-free survival (Kaplan–Meier) were analysed and compared according to several parameters (P

Background Lupoid cutaneous leishmaniasis (CL) is a rare form of CL having a striking resemblance to other granulomatous cutaneous conditions of infectious or inflammatory origin. The authors present a patient with a facial lupoid CL and discuss the diagnostic tools of this parasitological infection, the main differential diagnosis, and treatment. Case report A 54-year-old Tunisian woman, with no past medical history of lupus erythematosus or infectious disease, presented with a 3-month history of a slowly enlarging erythematous and infiltrated plaque, extending over the nose, the right cheek, and the internal aspect of the right lower eyelid. Microscopic examination of a parasitological smear showed numerous leishmania in their amastigote form, inside monocytes, confirming the diagnosis of CL. Clinical aspect was in favor of lupoid CL. The patient was cured by fluconazole 200 mg/day for 6 weeks after pancreatic intolerance with intramuscular meglumine antimoniate (60 mg/kg/day for 7 days), and no response to doxycycline (200 mg/day for 6 weeks). Discussion Lupoid CL is easily suspected in countries in which there is an endemic of leishmaniasis. In countries where there isn’t an endemic, although rarely observed, this diagnosis should also be kept in mind in front of an infiltrated facial lesion of a tuberculoid aspect on histology, especially when there is a positive travel history to an area in which there is an endemic.

The inflammatory myofibroblastic tumour has clinical, biological or histological features sometimes misleading with a septic condition. Presenting symptoms are variable and arising circumstances remain obscure. We report three cases occurring in a postpartum context. The first patient, a 28-year-old female, had left psoitis with a sepsis the first day postpartum in relation with an inflammatory myofibroblastic tumour of the meso-ovary. The second patient, a 40-year-old woman, had a hepatic inflammatory myofibroblastic tumour revealed by a ruptured sub-capsular haematoma of the liver in the forth day postpartum. The third patient, a 32-year-old woman, had a pulmonary inflammatory myofibroblastic tumour, diagnosed 5 months after a delivery and which recurred 10 years after surgical treatment. These cases illustrate the difficulty to diagnose inflammatory myofibroblastic tumour, particularly in postpartum.

Resume Introduction La tumeur a cellules geantes de type osteoclastique des glandes salivaires est extremement rare. Vingt-trois cas ont ete publies. Elle a ete rapportee sous 2 formes : isolee ou associee a un contingent carcinomateux. Observation Une femme âgee de 51 ans s’est presentee pour une tumefaction retro-angulomandibulaire gauche, indolore, evoluant depuis 2 ans. Cliniquement, elle correspondait a un nodule parotidien de 2 cm, sans paralysie faciale, ni adenopathie cervicale. Le nodule a ete emporte via une parotidectomie superficielle. L’examen microscopique a conclu a une tumeur a cellules geantes de type osteoclastique sans contingent carcinomateux associe. A l’immunohistochimie, les cellules mononucleees marquaient intensement et diffusement l’anti-pancytokeratine, alors que les cellules multinucleees en etaient negatives et fortement positives au CD68. La patiente n’a pas eu de traitement complementaire. A 23 mois de suivi, elle n’a pas presente de signe de recidive ni de metastase. Discussion L’histogenese et la nosologie de la tumeur a cellules geantes de type osteoclastique sont actuellement meconnus. Bien que cette entite n’ait pas ete integree dans la derniere classification de l’OMS, la majorite des auteurs la considerent comme une variante de carcinome. Les donnees de la litterature sont divergentes quant a la nature epitheliale ou histiocytaire des cellules multinucleees. Notre observation appuie l’hypothese d’une differenciation histiocytaire des cellules geantes et epitheliale des cellules mononucleees.

Resume Introduction Le but de notre travail etait d’etudier les facteurs influencant le taux des cytoponctions ganglionnaires cervicales non satisfaisantes (NS). Materiel et methodes Notre etude prospective a porte sur 272 cytoponctions ganglionnaires cervicales realisees en 2 ans (2010–2012). Le taux des resultats NS a ete etudie en fonction des criteres suivants : âge, taille des ganglions, localisations des ganglions, nombre de ponctions realisees, experience de l’anatomopathologiste pratiquant la ponction. Resultats Cinquante-six (20,6 %) des 272 cytoponctions realisees etaient NS car acellulaires ou tres peu cellulaires. Le taux des cytoponctions NS n’etait pas correle a l’âge des patients. Ce taux etait de 63,6 % pour les ganglions centimetriques ou infra-centimetriques (p = 0,01). Les localisations sous-angulo-mandibulaires et submandibulaires etait presentes dans 28 % des cytoponctions NS et dans 5 % des cytoponctions satisfaisantes (p = 0,001). Le taux des cytoponctions NS etait de 67 % si deux ponctions ou moins avaient ete pratiquees ; ce taux etait de 18 % si 3 ponctions ou plus etaient effectuees (p = 0,01). Ce taux etait de 77 % pour le premier semestre de l’etude, et de 8 % pour le quatrieme semestre (p = 0,001). La cytoponction a ete refaite pour 19 patients. Quatorze d’entre eux avaient eu une 2e cytoponction contributive ; ainsi refaire la cytoponction a augmente la rentabilite de la technique de 73,7 % (14/19). Discussion Le taux des cytoponctions ganglionnaires NS depend de la taille et de la localisation ganglionnaires et de l’experience de l’anatomopathologiste. En cas de prelevement NS, refaire la cytoponction augmente nettement la rentabilite de la technique.

Resume Objectif Le myxome odontogene est une tumeur benigne rare representant moins de 0,5 % des tumeurs osseuses et seulement 3 a 6 % des tumeurs odontogenes. Les auteurs rapportent quatre observations de myxome et procedent a une revue de la litterature concernant les aspects epidemiologiques, radiologiques, anatomopathologiques, therapeutiques et evolutifs de cette tumeur. Methodes Nous rapportons quatre cas de myxome odontogene recenses sur une periode de 23 ans. Resultats Il s’agissait de deux hommes et deux femmes dont l’âge variait de 19 a 38 ans. Trois tumeurs etaient de localisation mandibulaire et une maxillaire. Les explorations radiologiques ont montre dans les quatre observations un processus expansif osteolytique, multikystique. L’examen microscopique des quatre tumeurs presentait le meme aspect histologique fait de cellules fusiformes et etoilees non mitotiques au sein d’une trame mucoide alcalinophile abondante, confirmant ainsi le diagnostic de myxome. Les quatre patients ont eu un traitement conservateur et aucun n’a presente de recidive apres un recul de deux a huit ans. Conclusion Le myxome odontogene est une tumeur benigne rare, necessitant une confrontation des aspects anatomocliniques. Le diagnostic de certitude est anatomopathologique devant faire eliminer toutes les autres tumeurs a composante myxoide notamment les sarcomes. Le traitement doit etre radical reposant sur la chirurgie et une surveillance reguliere est indiquee.

Resume La tuberculose cutanee se caracterise par la multiplicite des formes anatomocliniques. Elle represente 2 % des localisations extrapulmonaires de la tuberculose. Nous rapportons une observation de tuberculose cutanee particuliere par une discordance des aspects anatomoclinique. Cas clinique Nous rapportons le cas d’une patiente de 29 ans, presentant de multiples lesions dont l’aspect clinique evoquait un lupus tuberculeux. L’histologie reproduisait l’aspect d’une tuberculose caseeuse. Le bilan radiologique decouvrait des lesions de tuberculose pulmonaire. L’intradermoreaction a la tuberculine etait positive. La recherche de bacille de Koch etait negative sur les prelevements cutanes et dans les crachats. Les lesions cutanees et pulmonaires ont evolue favorablement sous quadruple antituberculeux. Commentaire Notre patiente illustre les difficultes du diagnostic et de la classification de certaines formes de tuberculose cutanee. La multiplicite des lesions et leur siege, la presence d’une necrose caseeuse a l’histologie, l’association a une tuberculose pulmonaire evolutive ne sont, en effet, pas habituels au cours du lupus tuberculeux.

Resume Objectif Le but de ce travail a ete d’evaluer la valeur de l’examen extemporane en pathologie thyroidienne, ses limites et les moyens d’ameliorer sa sensibilite. Methodes Notre etude retrospective a analyse les resultats de 409 examens extemporanes realises sur des pieces de resections thyroidiennes sur une periode de quatre ans et leurs correlations avec l’examen histologique definitif. Resultats Dans notre serie, la confrontation des resultats de l’examen extemporane a ceux de l’examen definitif nous a permis de trouver un taux de concordance de 96,6 % et un taux de discordance d’environ de 3,4 %. Les discordances correspondaient toujours a des faux-negatifs. Aucun faux-positif n’a ete retrouve. La specificite de l’examen extemporane, tous types histologiques confondus, etait de 100 % et sa sensibilite etait de 68,2 %. Conclusion La fiabilite de l’examen extemporane de la thyroide est largement demontree. La grande specificite de cet examen temoigne de l’attitude des praticiens qui exigent une specificite quasi-absolue tout en gardant une sensibilite satisfaisante. Cependant, l’apport de cet examen reste limite pour le diagnostic des microcarcinomes et des carcinomes d’architecture microvesiculaire.

Resume Objectif L’objectif de notre etude a ete de montrer l’interet pronostique de la subdivision morphologique du carcinome papillaire renal et de comparer l’expression de MUC1 dans les deux types histologiques. Materiels et methodes Notre etude a porte sur 30 cas de carcinomes papillaires renal. Une relecture des lames a ete realisee en precisant le type histologique, le grade de Fuhrman et le stade pTNM. Une etude immunohistochimique a ete pratiquee dans 22 cas en utilisant l’anticorps MUC1. Resultats Il s’agissait de 23 hommes et sept femmes avec un âge moyen de 59,6 ans. Onze tumeurs sont de type 1 et 19 de type 2. Les tumeurs de type 2 ont ete significativement associees a un plus haut grade de Fuhrman que le type 1 (p = 0,0002). Nous avons montre une expression differentielle de MUC1 qui est exprimee frequemment dans le type 1. Deux patients ont developpe une recidive renale et une metastase pulmonaire et ont ete porteurs de type 2. La survie sans recidive ni metastase a ete de 100 % pour le type 1. Elle a ete de 79 % a 12 mois et de 59 % a 24 mois pour le type 2. L’expression de MUC1 a ete correlee a la survie. Conclusion Le carcinome papillaire de type 2 a ete associe a un haut grade; l’expression de MUC1 est plus frequente dans le type 1 et elle a ete correlee a la survie.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 5 - p. 457-462

Brenner tumors account for only 1 to 2% of ovarian tumors. Proliferating Brenner tumors are characterized by an epithelial proliferation, resembling superficial well-differentiated urothelial carcinomas. A single 29-year-old patient was operated for an ovarian tumor. On gross examination, the tumor, which originated in the left ovary, was cystic multilocular and presented polyoid excrescences. Definitive histological exam showed a papillary proliferation lined by transitional cells without stroma infiltration. Mucinous cells lined some cavities. The diagnosis of proliferating Brenner tumor was made. Clinical and pathological characteristics of this rare entity will be discussed.

Summary Introduction Adenomatoid odontogenic tumor, initially referred to as adenoameloblastoma, is a rare and benign odontogenic tumor. No recurrence has been reported after enucleation–resection. Case reports We report two cases of adenomatoid odontogenic tumor, which illustrate the radiological and anatomic features of this tumor. They occurred in two 21 and 14 years-old teenagers who presented gingival swelling. The panoramic radiographs showed a radiolucent lesion with an impacted tooth. Enucleation–resection was performed with good outcome. Discussion The clinical, radiological and histological features of adenomatoid odontogenic tumor are distinct from those of ameloblastoma. It affects most commonly patients in the second decade of life predominantly females. This tumor is frequently misdiagnosed as other odontogenic cysts or tumors. We discuss the anatomoclinical features and the histogenesis of this rare tumor.

The deficiency of mismatch repair system is one of the main pathways in colorectal cancer. This system consists mainly of four proteins: MLH1, MSH2, MSH6 and PMS2. Colorectal cancer develops in the majority of cases from precancerous lesions called adenomas. Only few studies have reported on the deficiencies of these proteins in adenomas.In this study we used immunohistochemistry staining in colorectal adenomas to assay functional status of MLH1, MSH2, MSH6, and PMS2 proteins.102 adenomas from 93 patients were collected in our institution during six years (2007-2012). The immunohistochemical technique was performed with 4 antibodies: MLH1, MSH2, MSH6 and PMS2. The loss of expression was retained if adenomatous cells were not stained with positive internal control. Staining was considered as abnormal if nucleus of adenomatous cells showed low nuclear staining and / or heterogeneous one, while positive internal control had normal staining.Loss of expression of MSH2 and MSH6 in adenomatous cells was found in only 1 case which was a tubular adenoma 3mm high-grade dysplasia. Abnormal staining of the adenomatous cells was noted in 23 cases (22.5%) for MSH2 and in 8 cases (7.8%) for MSH6. No cases showed loss of expression of MLH1 and PMS2. Abnormal expression of MSH2 and MSH6 was not correlated with sex of patients, the location of the adenoma, its grade of dysplasia and its histological type.Loss of Mismatch repair proteins expression is a rare event in adenomas. However, the abnormal expression levels are higher in our study compared to those reported in the literature. This could reflect a higher rate of microsatellite instability in our patients. Multicenter and larger studies with molecular biology techniques are needed.

The synchronous development of epithelial and stromal tumors of the digestive tract was rarely reported in the literature. Two such cases are described in this article. One is of a 44-year-old man presenting a high grade gastric stromal tumor associated with an adenocarcinoma of the large bowel. The other is of a 68-year-old man presenting an adenocarcinoma of the head of the pancreas associated with a low grade gastric stromal tumor. The hypothesis that the association is due to a simple coincidence particularly in areas with high rates of digestive cancer is proposed. A possibility of a genetic mutation or a single carcinogenic agent interacting with two tissues in the digestive tract and inducing the development of tumors of different histotype cannot be discarded.

Primary mucinous carcinoma of the skin is a rare sweat-gland neoplasm with a high recurrence rate. We report a new case of a primary recurrent mucinous carcinoma of the face in a 59-year-old man. Histopathologic examination of the neoplasm showed epithelial islands floating in mucoid material compartmentalized by fibrous septa. Cytokeratin 7, protein S100, estrogen and progesterone receptors were detected at immunohistochemical study, while cytokeratin 20 and actin were undetectable. Histologically, mucinous carcinoma of the skin can be mistaken for a metastasis from extracutaneous sites, particularly the breast or the gastrointestinal tract. Mucinous carcinoma of the skin has a relatively good prognosis with rare distant metastases, but high recurrence rate.

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors that arise from the wall of the gastrointestinal tract expressing CD117 and/or the CD34. Similar tumors were described in the soft tissue of the abdomen and are so-called extragastrointestinal stromal tumors (EGIST). We report 4 new cases of EGIST. The tumors occurred in 2 women and 2 men, who ranged in age from 42 to 71 years. Three tumors arose from the soft tissue of the abdominal cavity, and the remainder arose from the retroperitoneum. They ranged in size from 10 to 27 cm. Three cases were composed purely of short fusiform cells tumors, the last case showed an epithelioid pattern. All the tumors expressed CD117. One patient presented with local recurrence and metastasis, one was lost to the follow-up and two patients were doing well. Immunohistochemistry is useful in distinguishing EGIST from other mesenchymal tumors. Intra-abdominal aggressive fibromatosis may express actin and CD117 but catenin is also positive, leiomyosarcoma expresses the actin and/or desmin but CD117 is usually negative, retroperitoneal dedifferentiated liposarcoma is CD117 negative and PS100 positive, inflammatory myofibroblastic tumor is negative for CD117 and CD34. The solitary fibrous tumor expresses CD34 and is negative to CD117. Some tumors expressing CD117 such desmoplastic round cell tumor should not be confused with EGIST. On the occasion of these four observations, we will discuss the clinical aspects and the main differential diagnoses of this tumor.

Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.

Resume Introduction. – Les metastases osseuses d'un carcinome hepatocellulaire sont rares. Leurs sieges electifs sont les vertebres, les cotes et plus rarement le sternum. Nous rapportons une observation de metastase sternale revelatrice d'un carcinome hepatocellulaire. Exegese. – Un homme âge de 64 ans, ethylique, aux antecedents d'ictere, developpe depuis decembre 1999 une masse sternale de 15 cm de grand axe avec conservation de l'etat general. La biologie revele une cytolyse, une cholestase hepatique, une hepatite C positive et un taux d'alfafœtoproteine a dix fois la normale. Les radiographies standard ainsi que le scanner montrent une lesion lytique sternale et une volumineuse lesion hepatique droite. L'etude anatomopathologique de la tumeur sternale conclut a une metastase d'un adenocarcinome differencie. L'enquete etiologique a la recherche d'une tumeur primitive est revenue negative. Le geste operatoire est recuse devant l'aspect infiltratif de la tumeur et sa proximite des gros troncs vasculaires, une radiotherapie a permis une regression partielle de la tumeur. La relecture de la biopsie conclut a un aspect d'hepatocarcinome bien differencie. Le malade est decede 22 mois apres l'apparition de metastase sternale. Conclusion. – Notre observation est particuliere par la revelation du carcinome hepatocellulaire par une metastase sternale, la conservation de l'etat general, la survie prolongee et la regression partielle sous radiotherapie.

The lung, the liver, the bone tissue and the brain are the most frequent sites for renal cell carcinoma metastasis. Small bowel metastasis from renal cell carcinoma is rare, with only few cases published. We report the case of ileal metastasis from operated kidney cancer revealed by ileocolic intussusception and causing intestinal obstruction in a 32-year-old woman.

Resume Le liposarcome est une tumeur mesenchymateuse, maligne, primitive et rare. Nous rapportons l’observation d’une femme âgee de 32 ans qui a eu en 1997 une exerese complete d’un liposarcome retroperitoneal geant de type myxoide de 15 cm. Trois mois plus tard, elle a eu une exerese d’une recidive locale de 9 cm suivie d’une radiotherapie. En 2000, elle a presente une recidive retroperitoneale associee a une autre localisation du grele. La tumeur retroperitoneale etait inextirpable. Elle a eu une resection anastomose intestinale suivie d’une chimiotherapie. En revoyant la litterature, les aspects pathologiques, therapeutiques et pronostiques de cette tumeur sont degages.

We report a new case of postvaccination morphea profunda (MP) in a child and discuss its different clinical presentations, prognosis, and therapy and its relationship with "solitary morphea profunda." A 2-year-old healthy girl presented with an induration of the anterior aspect of the left thigh of 9 months duration. The lesion had appeared 3 months after a third dose of diphtheria-tetanus-pertussis vaccine. Cutaneous examination showed an induration of 7 × 7 cm with an "orange peel" texture after pinching the skin. Histologic examination confirmed the diagnosis of MP. Systemic steroids (1 mg/kg/day) led to the stabilization of the lesion. After 4 months of treatment, we began the concomitant use of oral methotrexate (10 mg/wk) for 2 months. Methotrexate was then continued alone for 10 months, leading to a significant regression of the induration with no relapse.

Resume Introduction Le fibrome odonto-ameloblastique (FOA) est une tumeur odontogenique mixte tres rare (2 % des tumeurs odontogeniques). Elle est souvent localisee et peu agressive. Les recidives et les transformations malignes sont possibles. Nous presentons le cas d’un volumineux FOA mandibulaire de l’enfant. Observation Un enfant âge de sept ans presentait une tumefaction mandibulaire droite de 10 cm qui deformait le relief facial. La muqueuse etait saine. La radiographie panoramique et la tomodensitometrie du massif facial montraient une volumineuse image kystique, monogeodique, qui prenait l’angle, le corpus et le ramus mandibulaire droits. Elle etait associee a une dent incluse. Le kyste a ete enuclee et la cavite curetee. Il n’y pas eu de recidive a dix mois. Discussion Notre observation se distingue par le jeune âge de l’enfant, la grande dimension de la tumeur et l’absence de recidive apres exerese chirurgicale. Le FOA survient le plus souvent au niveau de la region posterieure de la mandibule. Il interesse habituellement le sujet jeune dans les deux premieres decennies de la vie. Les signes radiocliniques orientent le diagnostic et l’anatomo-pathologie permet de le confirmer. L’exerese chirurgicale complete permet d’eviter les recidives.

Resume Les oncocytomes renaux presentent des particularites diagnostiques et pronostiques. Nous rapportons une etude retrospective realisee entre 1987 et 1999 dans le service d'urologie de l'hopital Charles Nicolle. Il s'agit de sept cas repertories parmi 120 carcinomes a cellules renales. Les aspects radiologiques, echographiques, tomodensitometriques et arteriographiques, ne permettent pas d'affirmer avec certitude le diagnostic d'oncocytome en preoperatoire. Le diagnostic est anatomopathologique. L'oncocytome est une tumeur renale benigne. Le traitement chirurgical conservateur doit etre preconise a chaque fois qu'il est realisable.

Resume L'hemodialyse au long cours est sujet a des complications diverses. L'amyloidose generalisee est l'une d'entre elles. Elle resulte d'un depot de β2-microglobuline non epuree par l'hemodialyse. L'atteinte digestive peut entrainer des accidents ischemiques tels que l'ulcere, l'infarctus, l'hemorragie digestive, la pseudo-occlusion et la perforation realisant ainsi une urgence chirurgicale. Notre observation represente le sixieme cas de perforation intestinale par amyloidose rapporte dans la litterature.

Collecting duct carcinoma is an extremely rare disease, representing less than 1% of all renal tumours. The authors report the case of a 72-year-old patient presenting with right low back pain associated with episodes of total macroscopic haematuria. Imaging showed a heterogeneous mass in the upper pole of the right kidney associated with pyelocaliceal stones. Multiple secondary lesions were observed in the liver. Macroscopically, the mid-renal tumour was 7.5 cm in diameter surrounding the stone-containing pyelocaliceal cavities. This tumour had spread to the cortex and invaded the perirenal fat. Histologically, the tumour was composed of ducts lined by cells with a hobnail appearance in an abundant desmoplastic and neutrophil-rich inflammatory stroma. Immunohistochemistry showed very intense labelling of tumour cells with cytokeratins: KL1, 7, 19, and 34_E12 and slightly less intense labelling with UER, Vimentin, EMA, and BNH9, while cytokeratin 20 was negative. The diagnosis of Fuhrman grade 3 collecting duct carcinoma associated with renal stones and liver metastases was adopted. The patient died postoperatively. The main differential diagnosis was urothelial carcinoma with a glandular component. In the present case, the diagnosis was made more difficult by the concomitant presence of renal stones. The diagnosis was established by histology and immunohistochemistry.

The authors report the case of a 40-year-old woman, who was operated for an ovarian mucinous cystadenocarcinoma. The pathologic findings of the hysterectomy specimen with bilateral salpingoophorectomy showed an ovarian mucinous cystadenocarcinoma associated with an endometrioid adenocarcinoma of the uterine cervix. The mucinous cystadenocarcinoma represents the third most common type of ovarian carcinoma. In the literature, this tumor had been found in association with endocervical adenocarcinoma or with minimal deviation adenocarcinoma (adenoma malignum) of the uterine cervix. However, its association with an endometrioid adenocarcinoma, to our knowledge, has not been reported.

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used.To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma.We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables.Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later.Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL.

IgG4-related diseases are a recently recognized systemic syndrome characterized by mass-forming lesions, in mainly exocrine tissue, that consist of lymphoplasmacytic infiltrates and sclerosis, which may mimic malignant neoplasm due to clinical and imaging features. We report an unusual case of a 62-year-old woman who presented with a left orbital mass, which histologically revealed to be an IgG4-sclerosing disease.