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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 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.

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.

The pancreatic cystic serous neoplasms are divided into two categories: benign serous cystadenoma (SCA) and malignant serous cystadenocarcinoma. Furthermore, based on the macroscopic appearances, SCAs are subdivided into serous microcystic adenomas (SMAs) and serous oligocystic or macrocystic adenomas.Report of a new case of SMA in which we emphasize on the diagnostic difficulties encountered against such tumor despite its relatively radiological easiness compared to the other variants.We report the case of 84 year-old-woman with a microcystic serous cystadenoma of the pancreas which was identified on pathologic examination of the surgical specimen, after unconclusive abdominal ultrasound and computed tomography (CT)- scan.This case describes this rare entity and emphasizes that the diagnosis of such entity is still based on pathological examination after tumor removal.

Basal cell adenoma (BCA) is a rare benign neoplasm characterized by the basaloid appearance of the tumour cells and the lack of myxo-chondroid stromal component present in pleomorphic adenoma.We report a case of basal cell adenoma of membranous type, highly suspected of malignancy because of the presence of mediastinal lymph nodes and pulmonary nodules which finally were related to an associated sarcoidosis.Our patient was an 80-year-old woman who presented a swelling of the right parotid two years ago. The clinical examination revealed a solid, indolent and mobile mass. A chest radiography noted mediastinal lymph nodes. The CT-scan confirmed the presence of mediastinal and tracheal lymph nodes with pulmonary nodules. So the diagnosis of metastatic malignant salivary gland tumor was suspected. Finally, the histological examination concluded to a basal cell adenoma of membranous type with sarcoidosis granulomas in the parotid and in the lymph nodes.The BCA is a benign tumor located generally in the parotid gland. When the malignancy is suspected, like in our case, this tumor must be differentiated from the basal cell adenocarcinoma using histological criteria.

Most of the sinonasal tumours are of epithelial origin. Leiomyomas are very uncommon in the upper respiratory tract and extremely rare in the nasal cavity and paranasal sinuses. They account for less than 2.5% of the mesenchymal neoplasms of the sinonasal tract and the nasopharynx.Report of a new case which will be added to the 30 cases of primary sinonasal leiomyogenic tumours reported in the litterature. The clinical and pathological characteristics of this tumour will be discussed.We report a case of 48-year-old woman complaining of nasal obstruction corresponding to a polypoid lesion of the sinonasal cavity. The histological examination of the removed mass concluded to a leiomyoma.Leiomyoma in this location has no specific physical or radiological findings. Only the histological examination can definitively made the correct diagnosis.

Solid pseudopapillary tumors of the pancreas are extremely rare and mostly seen in young females. It is often diagnosed incidentally or during investigations of gastrointestinal complaints.Report of a pediatric case of this tumor.We report the case of a 15-year old teenager who presented with painful abdominal tumefaction. Imaging findings were a 12 cm solid and cystic mass originating from the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. Pathologic examination concluded to solid pseudopapillary tumor. Evolution was favorable with no recurrence 18 months after surgery.Histological examination confirms the diagnosis and allows, with the help of immunohistochemical study, to rule out some differential diagnoses such as pancreatoblastoma, acinar tumors and endocrine tumors. Prognosis of solid pseudopapillary tumors of the pancreas is excellent after radical resection and recurrences are rarely seen.

Swyer syndrome is a distinct type of pure gonadal dysgenesis characterized by a 46 XY karyotype in female phenotypic patients. It shows an abnormality in testicular differentiation. It is usually revealed by primary amenorrhea. The tumor that usually develops in Swyer syndrome is gonadoblastoma. Although gonadoblastoma is considered benign, the risk of malignant germ cell tumor development is high.The aim of this report is to stress on the risk of occurrence of malignant germ cell tumors on these dysgenesic gonads.We present the clinical, sonographic and endocrine findings in the case of a 13 year-old phenotypic young girl with a 46 XY karyotype and gonadal dysgenesis. The patient underwent surgery for adnexal torsion. An examination of the gonads revealed gonadoblastoma associated to dysgerminoma. The treatment and the follow up are detailed.The presence of Y chromosome in the karyotype of a patient presenting a gonadal dysgenesis must lead to prophylactic bilateral gonadectomy in order to avoid a malignant transformation. Gonadectomy must be followed by a hormone replacement therapy.

The ovarian tumors' diagnosis is based on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis.The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis.We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors.The average age of our patients was 51,3 years with an average size of 8,4cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and S-100 protein.The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors.

The intraoperative frozen section is a well established procedure for rapid diagnosis that helps in making therapeutic decisions.Assessment of the accuracy of frozen section diagnosis and analysis of the causes of its discordance.A retrospective review of 1695 surgical specimens performed in 1207 patients between January 2002 and April 2005. Frozen section results were compared with the final diagnoses in paraffin sections.The frozen section diagnosis was benign in 84.2%, malignant in 10.2% and borderline in 0.4% of all cases. The frozen section result was deffered to permanent section in 5.2%. The sensitivity, specificity, positive and negative predictive values were 84.6%, 99.8%, 98.2% and 97.8% respectively. Overall diagnostic agreement was 97.5% (Kappa=0.88). Frozen section diagnosis was incorrect in 2.5% of cases. Most of the discrepancies were false negative cases frequently due to sampling errors and misinterpretation. False positive cases were always related with misinterpretation.The frozen section evaluation is highly accurate and reliable. However, the surgeon and the pathologist must be aware of its limitations.

Odontogenic myxoma is an uncommon tumor that represent less than 0,5% of all bone tumors and only 3 to 6% of odontogenic tumors. The aim of this article was to catalogue the clinical cases diagnosed microscopically as odontogenic myxoma and to describe their clinical and radiographic characteristics, comparing these to the data found in the current literature.Histological and immunocytochemical examinations were performed on odontogenic myxomas from four Tunisian patients in a period of 23 years.In the present series, two were male and two female. The age at diagnosis ranged from 19 to 38 years. Three tumors involved the mandible and one occurred in the maxilla. In all cases with radiographic records, lesions presented with a multilocular and osteolytic appearance. Histologically, odontogenic myxomas were mainly composed of spindled or stellate-shaped cells in a mucoid-rich intercellular and alcian blue positive matrix. All cases were treated by tumor-enucleation. There was no evidence of recurrence after 2 to 8 years.Clinical and radiological aspects of odontogenic myxomas are not conclusive; a histopathological examination of the lesion is mandatory in order to make the right diagnosis. Because of its high rate of recurrence, surgical treatment through bone resection is the most indicated treatment modality, and the patient must be followed-up closely for years.

The purpose of this study was to assess the value of intraoperative frozen section diagnosis in thyroid surgery and determine its limitations.This retrospective study examined the results of 409 frozen sections of thyroid specimens analyzed over the 4-year period and their correlations with the final histological examination.In our series, frozen section diagnosis was concordant with subsequent histopathological examination in 96.6% of cases, discordant in 3.4%. All discordances were due to false-negative diagnoses. Non-false-positive result was found. The global specificity of frozen section analysis for all histological subtypes was 100% and its sensitivity was 68.2%.The frozen section evaluation of thyroid neoplasm is highly accurate and specific. A high degree of specificity with an acceptable sensitivity is requested. However, the frozen section examination has still some limits in the diagnosis of microfollicular lesions.

Adenomas of the stomach are histologically classified into tubular, villous and mixed (tubulovillous) adenoma. In the literature, in two previous studies, only six cases of serrated adenoma of the stomach have been reported. In this communication, we report a newly identified case. The patient presented with gastric complaints. The endoscopic examination showed a pediculated protruding tumour localised in the gastric corpus. Biopsies were reported as tubular adenoma with high-grade dysplasia. A surgical local excision of the tumour was performed. The histological examination revealed elongated fronds with lateral crenated, saw-tooth-like notches as a result of scalloped epithelial indentations. Areas with high grade dysplasia but without invasive carcinoma were demonstrated. This seems to be the first case of serrated adenoma localised in the gastric corpus in the literature. Rubio1 reported the …

In a retrospective study of the specimens of gastric polypectomy, carried out between January 1992 and December 2002, we analysed the demographic and histological aspects of 65 polyps. This study revealed hyperplastic polyps in 66%, adenomatous lesions in 9.2%, Peutz-Jeghers polyps in 7.7%, inflammatory fibroid polyps in 6.15%, two cases of focal foveolar hyperplasia (3%), two cases of Brunner's gland heterotopia (3%), 1 pancreatic heterotopia (1.5%), 1 fundic gland polyp (1.5%) and 1 carcinoid tumor (1.5%). All adenomas and two Peutz-Jeghers polyps include intraepithelial neoplasia. Moreover, we identified a case of Brunner's gland heterotopia, which contain a focus of plane tubular adenoma with high-grade intraepithelial neoplasia. Other lesions were found within the polyps or into the surrounding gastric mucosa, such as intestinal metaplasia and Helicobacter Pylori gastritis. This work allowed us to recommend complete removal of gastric polyps and the realization of biopsies of the nonpolypoid gastric mucosa in the search of intraepithelial neoplasia or other lesions with malignant potential.

The emphysematous pyelonephritis is a rare and severe renal infection characterized by the presence of gas in renal parenchyma and its perirenal spaces. We report two cases of emphysematous pyelonephritis in two diabetic women (53 and 50 years old respectively). In the first case, the treatment was based on nephrectomy because of the presence of a septic shock and three risk factors, which are acute renal failure, hematuria and thrombopenia. In the second case, the treatment was only medical. The evolution was favorable in the two cases. We insist in this article that this diagnosis should be considered in every female diabetic patient having severe acute pyelonephritis resistant to a well-conducted medical treatment.

Suprasellar germinomas are frequent in childhood and adolescence, particularly in male sex. The clinical and neuroendocrine abnormalities depend of tumor localization: Increased intracranial pressure, visual disturbances, hypopituitarism, Parinaud syndrome. We report two cases of suprasellar germinoma in young male patients (16 and 18 years old). The first patient hrad corticotorpin insufficiency and clinical signs of hypothyroïdism and hypogonadism. The second had central hypocorticism, hypothyroïdism and hypogonadism associated with central diabetes insipidus and hyperprolactinemia. The diagnosis of germinoma was confirmed after surgery by anatomopathologic examination in the first case and by stereotaxic biopsy in the second case. Treatment by radiotherapy improves prognosis of this disease.

Mycosis fungoides is an epidermotropic cutaneous T lymphoma. It's a non Hodgkinian lymphoma. We report the results of a retrospective review of 11 mycosis fungoide seen during 22 years. The frequency of MF was about 39.3% among all cutaneous lymphoma. Six patients were male and 5 were female; the mean age was about 56 years. Mean delay between diagnostic and the first manifestation was about 25 months. All patients had the progressive form: 4 had infiltrate plaques and 7 were at the tumoral phase. Lymph nodes and medullar metastases were noted respectively in 1 and 2 cases. Treatment was mono or polychemotherapy associated in 6 cases with topical drug. Three patients died of their diseases According to our experience and after reviewed the literature, we notice that our patients are slightly younger without male predominance. The diagnostic was done tardily and this may explain the pejorative prognostic.