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Summary: Repeated spontaneous miscarriages are defined as at least three consecutive episodes of spontaneous miscarriage, less than 14 weeks of amenorrhea, with the same partner, in a patient under 40 years of age. 80% of these patients have an identifiable cause justifying an etiological approach. A guided history and clinical examination are necessary. An etiological assessment is to be carried out: a pelvic ultrasound and a hormonal assessment in the woman, as well as a karyotype of the two members of the couple. The other examinations are requested as a second intention. The main causes are balanced chromosomal abnormalities of the parents, sperm DNA fragmentation, congenital malformations and lesions of the uterine cavity, anti-phospholipid syndrome, unbalanced diabetes, dysthyroidism and luteal insufficiency. In the event of an identified cause, certain therapeutic or preventive measures must be discussed in order to limit the risk of recurrence.

Pyoderma gangrenosum (PG) is a rare inflammatory neutrophilic dermatosis for which accurate epidemiological data are limited and therapy remains a challenge. The primary study´s aim was to examine all cases of PG observed in our department over a 6-year period in order to describe the relevant characteristics and outcome under therapy. Fourteen patients were included (5 women, 9 men). The average age of our patients was 40,15 years. The classical, ulcerative form was found in 10 cases (71.42%), the pustular form in 4 cases (27.57%) and PG was multifocal in 4 cases. The PG was located preferentially to the lower limbs. Histological examination was realized in all patients and objectified inflammatory infiltrate composed of polymorphonuclear neutrophils in all cases with vasculitis in 4 cases. Six patients (42.85%) had associated disease at diagnosis of PG, including inflammatory bowel disease in two cases (14.28%), a blood disease in 2 cases (14.28%), lymph node tuberculosis and inflammatory arthritis in 1 case (7%). The most frequent first-line treatments were oral corticosteroids (7 cases) and other treatments used were colchicine in 2 cases, topical corticosteroids in 3 cases with good clinical evolution. Our study confirms that PG is a rare disease, associated in almost half of cases with systemic disease already present at diagnosis; in our Moroccan background, it is most often inflammatory bowel disease, hematological or solid cancer and tuberculosis.

Functional dyspepsia constitutes by its impact in quality of life and socio-economic impact areal public health problem (40% of the adult population in the Western world). The prevalence of infection with Helicobacter pylori (HP) in patients with functional dyspepsia is about 30% - 70%. The aim of our study is to observe the improvement of functional dyspepsia (FD) after Helicobacter pylori (HP) eradication. Methods: This is a prospective study over a period of 68 months (May 2009 - January 2015). We included all patients aged over 15 years, with functional dyspepsia defined by the Rome III criteria. The diagnosis of HP was made by histology and/or PCR. Patients infected with HP were treated in single-blind: standard triple therapy for 7 days or sequential treatment for 10 days. HP eradication control was made after: 3 months, 6 months and one year of treatment. Results: During the study period, 1190 patients were included of which 250 patients (21%) were in functional dyspepsia according to the Rome III criteria. The average age in patients with functional dyspepsia was 49 years [16 - 80], sex ratio M/F was 0.58 (N = 92/158). 60% of patients were older than 45 years (N = 150). Chronic smoking was found in 20% of patients (N = 50). One hundred and seventy five patients (70%) had HP infection (N = 175). One hundred and sixty five patients received the treatment of Helicobacter pylori (94.28%), 10 patients were lost to follow (5.71%). The eradication of HP was obtained in 98.41% with sequential treatment versus 88.73% with standard triple therapy (p = 0.026). All patients were reviewed at 3 months and 6 months after treatment, 86% were reviewed at 12 months (N = 143). Dyspeptic symptoms was disappeared in 43% of our patients (N = 71) partial disappearance of symptoms in 34.5% of cases (N = 57) persistence of symptoms in 22.42% of cases (N = 37). Conclusion: In our study the prevalence of Helicobacter pylori infection in patients with functional dyspepsia is high: 70%. Sequential therapy is better than the standard triple therapy in the eradication of HP in patients with nonulcer dyspepsia, which improves their symptoms in more than 50% of cases.

La chirurgie micrographique de Mohs (CMM) est une technique permettant le contrôle histologique per-opératoire de la totalité de la marge d'exérèse chirurgicale des tumeurs malignes. Le but de ce travail est de valider l'intérêt de la CMM dans la guérison maximale des carcinomes basocellulaires (CBC) chez nos malades. Sur une période de 5 ans, nous avons retenu 29 patients présentant un CBC de la face. La médiane d'âge était de 45,8 ans (12-80). Le sex-ratio H/F était de 1,23. Une seule étape était nécessaire pour une exérèse complète dans 51% des cas. Le recours à 3 étapes était nécessaire dans 14% des cas. La durée moyenne de l'intervention a été d'une heure pour les cas ne nécessitant qu'une seule étape. Aucune complication n'a été rapportée en post opératoire et les suites étaient simples. Le résultat esthétique et fonctionnel était satisfaisant. Aucune récidive n'a été notée. Le CBC représente environ 80% de tous les cancers de la peau. La décision de traiter le CBC par CMM est basée sur trois variables: le siège et la taille de la tumeur, l'aspect histologique avec la définition de la marge d'exérèse et le caractère récidivant. La CMM est actuellement la méthode la plus efficace pour le traitement du CBC et permet la préservation du maximum de tissu sain. C'est une méthode chirurgicale sûre et reproductible, fondée sur un travail d'équipe et adaptée au traitement des CBC à haut risque de récidive. Les résultats esthétiques et fonctionnels sont satisfaisants. Le taux de récidive à 5 ans est 10 fois inférieur aux autres méthodes.

Post traumatic diaphragmatic injuries have long been known. However their varied clinical, expressions lead to difficulties which cause its delay. The occurrence of herniation of hollow viscera in the thoracic cavity followed by its necrosis or perforation, is a delayed complication, a rare entity with a poor prognosis. The discovery of a colonic tumor in a diaphragmatic hernia is an exceptional clinical circumstance. Here we report the case of a patient with a complicated diaphragmatic hernia, whose symptoms are precipitated by the presence of a colon stenosing tumor. The management consisted of an exclusive laparotomy had allowed dealing in one surgical intervention with both the abdominal and thoracic injuries.

Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present a 66-year-old man operated for kidney cancer 20 years ago and has consulted for a scrotal lesion that had started 20 days. The physical examination revealed an erythematous lesion. A biopsy of the scrotal skin was made. We found a scrotal metastasis of renal cell carcinoma.

Helicobacter pylori (H. pylori) infection induces inflammation of the gastric mucosa, which may progress to precancerous lesions leading to gastric cancer. Pathological determinism is associated to some virulence genes of the bacterium, notably the vacA and cagA genes. The present study aimed to determine the H. pylori genotypes distribution and their association with sex, age and gastric diseases in a Moroccan population. Gastric biopsy was taken from 1079 consenting patients. The specimens were processed by PCR to identify H. pylori and to determine the genotypic profile by PCR characterizing vacA s, vacA m and vacA i regions directly from biopsies H. pylori positives. VacA genotyping revealed the predominance of vacA m2 (53.2%), vacA s2 (52.9%) and vacA i2 (52%). The most virulent vacA alleles (s1, i1 and m1) are more predominant in men (47.3%, 41.9% and 46.1% respectively) than in women (38.3%, 33.3% and 37% respectively). However, the association between vacA genotypes and age did not reach a statistical significant value. Logistic regression analysis results show that vacA i1m1 and vacA i1m2 genotypes were strongly associated with the risk of GC, the Odds Ratio (95% confidence interval) was 29.73 [5.08–173.73] and 9.17 [2.06–40.82] respectively, while vacAs1/cagA+ seems to be a risk factor for DU since it is inversely associated with GC (OR was 0.13 [0.02–0.75]. The results of this study suggest that vacA i1 genotype independently to vacAm status may be of a clinical usefulness and will help to identify patients at a high risk of GC development.

Resume Introduction La fasciite avec eosinophilie, ou syndrome de Shulman (FE), est une maladie rare, de cause inconnue et dont le cadre nosologique n’est pas clairement defini. Elle est caracterisee cliniquement par un œdeme et une induration des membres avec hypereosinophilie sanguine. Elle peut etre associee a des morphees, ce qui constituerait un facteur de mauvais pronostic, et a d’autres maladies, notamment auto-immunes. Nous rapportons un cas d’association fasciite a eosinophiles, morphees et vitiligo. Observation Un patient de 45 ans, suivi pour vitiligo depuis 20 ans, presentait depuis 7 mois un gonflement et une induration cutanee des quatre membres associes a des morphees du tronc. Un traitement par corticotherapie generale et methotrexate etait institue, avec une certaine efficacite. Discussion L’association morphees/fasciite avec eosinophilie est classique ; la presence d’un vitiligo fait discuter un lien possible entre ces differentes affections.

L'apport de la ponction biopsie rénale (PBR) dans le diagnostic, le choix thérapeutique et l'évaluation pronostique des néphropathies est considérable. Aucune étude marocaine n'a évalué la pratique et l'apport de la PBR. Notre objectif est d'étudier les indications de la PBR, déterminer la fréquence des maladies rénales identifiées par PBR dans notre région et de faire une confrontation entre les données clinico-biologiques et le diagnostic historique. Notre étude menée entre Janvier 2009 et Décembre 2012, est rétrospective. Nous avons inclus tous les patients du service de Néphrologie du CHU Hassan II de Fès ayant bénéficié d'une biopsie de reins natifs. 522 PBR ont été réalisées. Nous avons exclu 8 biopsies devant le manque de renseignements et avons donc retenu 514. L'âge moyen des patients au moment de la PBR est de 39 ±17 ans (3-82 ans). Le sex ratio est de 0,9. Le syndrome néphrotique est le diagnostic clinique le plus fréquent à tous les âges (58,2%). Les néphropathies glomérulaires représentent 94,2% des maladies rénales diagnostiquées, leur distribution varie selon l'âge des patients. La PBR a confirmé le premier diagnostic suspecté cliniquement dans 40,65 % des cas, alors qu'elle a révélé un diagnostic inattendu chez 22,5% d'entre eux. Le diagnostic syndromique permet d'orienter vers la maladie rénale la plus probable et de guider les thérapeutiques urgentes en attendant les résultats de la PBR. Mais il ne peut en aucun remplacer la PBR qui reste le gold standard.Pan African Medical Journal 2016; 24

Resume L’invagination intestinale aigue est une pathologie du nourrisson et du petit enfant. Sa survenue chez l’adulte est tres inhabituelle. Elle est d’etiologie diverse. Le lipome est rare au niveau du tube digestif. L’invagination intestinale sur lipome est exceptionnelle. Nous rapportons un cas d’invagination intestinale grelo-grelique sur lipome.

Background Finding a simple, accurate, and noninvasive diagnosis method is a substantial challenge for the detection of Helicobacter pylori . The aim of the present study was to compare the presence of H. pylori urease antigen in saliva with the presence of this bacterium in gastric mucosa. Methods Saliva samples and gastric biopsies were taken from 153 consenting Moroccan patients. Saliva samples were analyzed using an immunochromatographic test for urease antigen H. pylori detection. Thereafter, the gastric biopsies were analyzed by histology and polymerase chain reaction (PCR) to detect this bacterium. Results From a total of 153 recruited Moroccan patients, H. pylori was detected in 28 (18.30%), 87 (57.24%), and 69 (45.10%) cases by saliva test, histology, and PCR, respectively. A significant association was observed between the presence of H. pylori antigen in saliva and age. However, no association was found with sex, H. pylori virulence factors, gastric disease outcome, and density of the bacterium on the gastric mucosa. Considering that only 90 patients presented concordant results on H. pylori diagnosis (positive or negative) by both histology and PCR, the immunochromatographic test showed very low sensitivity (29.79%) and high specificity (90.70%). Of these two tests, the positive and negative predictive values were 77.78% and 54.17%, respectively. The accuracy of the test for salivary detection of urease antigen H. pylori was 58.89%. Conclusion This study demonstrated a low detection rate of H. pylori antigens in saliva compared with the presence of this bacterium in gastric mucosa, suggesting that saliva cannot be used as a suitable sample for the diagnosis of H. pylori in our study population.

Background Colorectal Cancers (CRC) are one of the most common malignancies in the world. Their incidence in Morocco, between 2005 and 2007, was 5.6 for 100000 inhabitants, which is very low compared to what found in developed countries. In addition, CRCs show a high frequency of rectal localizations, and occurs in a younger population in Morocco compared to what found in developed countries. The purpose of this study is to confirm these CRC peculiarities in Morocco and try to explain them by exploring the microsatellite instability molecular pathway. Methods This is a prospective observational study conducted since January 2010, including 385 patients admitted in Hassan II University Hospital of Fez. We collected clinical, radiological and pathological data. We investigated the expression of mismatch repair (MMR) proteins in 214 patients and BRAF gene mutations in 159 patients. Results Mean age was 55.08 +/− 15.16 years. 36.5 % of patients were less than 50 years old and 49.3 % of tumors were localized in the rectum. Loss of MMR protein expression was observed in 11.2 % of cases. It was independently associated with individual or family history of cancer belonging to Hereditary Non-Polyposis Colorectal Cancer (HNPCC) spectrum (p = 0.01) and proximal localization (p = 0.02). No BRAF mutation was detected in all cases. Conclusions These results confirm the high occurrence of CRCs to young patients and the high frequency of rectal localizations in Moroccan population. They mostly show an absence of BRAF mutation, supposing a rarity of MLH1 promoter hypermethylation pathway, which may even partially explain the CRC peculiarities in our context. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5868184711716884

Lipomatous meningiomas are rarely encountered and are included in the World Health Organization's (WHO) group of metaplastic meningiomas. We report two cases of these tumors. The presenting symptoms were headaches in one case and seizure in the other. Radiologically, these tumors were extra-axial and unique. One tumor displayed fat accumulation, while the other had the appearance of a conventional meningioma. Microscopically, these tumors corresponded to meningothelial and transitional meningiomas containing a variable proportion of adipose tissue composed of mature adipocytes or lipoblasts. Fat content was high in one case and moderate in the other, thus explaining the radiological findings. Expression of epithelial membrane antigen and progesterone receptors was present in meningothelial, adipocyte-like, and lipoblast-like cells. These immunohistochemical results suggest that lipid accumulation in meningioma should be considered a transformation of meningothelial cells rather than a true metaplasia.

Granular cell tumor (GCT) was first described by Abrikossof in 1926. This tumor is a benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. GCT is not common and most often affects the tongue, skin, and soft tissue, although it may occur anywhere in the body. Gastrointestinal tract involvement, and especially that of the colon, is very rare. This usually benign tumor appears as a submucosal nodule, measuring less than 2 cm in diameter and is often found incidentally during colorectal examinations. We describe the case of a 27-year-old man with a GCT in the cecum that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 0.7 cm in diameter. An endoscopic mucosal polypectomy was done for histological confirmation and treatment.

Apocrine carcinoma of the male breast is an exceptional malignant tumor. It does not have a particular clinical or radiological appearance, but it's microscopically characterized by the presence of granular cells and foamy cells representing over 90% of tumor cells. These cells express most of the time the GCDFP-15 and the androgen receptors. This tumor is a distinct molecular entity. In this observation, we report the case of a 70 year old man presenting apocrine carcinoma of the left breast diagnosed at the stage of lung metastasis.

Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur mesenchymateuse cutanee de malignite intermediaire. C'est une tumeur rare mais non exceptionnelle, representant 0,1% des tumeurs cutanees malignes. Les auteurs presentent une etude retrospective de 27 cas de DFS diagnostiques sur une duree de 7 ans (2004 a 2010) et la comparent aux donnees de la litterature. Cette etude permet d’etablir en plus des caracteristiques anatomopathologiques et immunohistochimiques, une etude epidemiologique, clinique et evolutive de ce sarcome. l’âge moyen de nos patients est de 41 ans avec une predominance masculine. Le tronc est la localisation preferentielle touche dans 52% des cas. La taille tumorale a atteint 30cm et mesure en moyenne 6,1 cm. Le diagnostic etait evoque a l'examen histologique standard et confirme par l'expression intense et diffuse du CD34. Le traitement etait chirurgical, associe a une radiotherapie dans 2 cas. L’evolution etait marquee par la transformation en un sarcome pleomorphe de haut grade dans un cas et par la survenue de recidives locales dans 2 cas. Nos resultats sont classiques et comparables aux autres series de la litterature. L'examen histologique est indispensable pour le diagnostic. L'exerese chirurgicale large est le traitement de reference. Le pronostic est conditionne par une malignite surtout locale et un fort potentiel de recidive. La transformation sarcomateuse franchement maligne metastasiante est exceptionnelle.

L'apport de la ponction biopsie rénale (PBR) dans le diagnostic, le choix thérapeutique et l’évaluation pronostique des néphropathies est considérable. Aucune étude marocaine n'a évalué la pratique et l'apport de la PBR. Notre objectif est d’étudier les indications de la PBR, déterminer la fréquence des maladies rénales identifiées par PBR dans notre région et de faire une confrontation entre les données clinico-biologiques et le diagnostic historique. Notre étude menée entre Janvier 2009 et Décembre 2012, est rétrospective. Nous avons inclus tous les patients du service de Néphrologie du CHU Hassan II de Fès ayant bénéficié d'une biopsie de reins natifs. 522 PBR ont été réalisées. Nous avons exclu 8 biopsies devant le manque de renseignements et avons donc retenu 514. L’âge moyen des patients au moment de la PBR est de 39 ±17 ans (3-82 ans). Le sex ratio est de 0,9. Le syndrome néphrotique est le diagnostic clinique le plus fréquent à tous les âges (58,2%). Les néphropathies glomérulaires représentent 94,2% des maladies rénales diagnostiquées, leur distribution varie selon l’âge des patients. La PBR a confirmé le premier diagnostic suspecté cliniquement dans 40,65% des cas, alors qu'elle a révélé un diagnostic inattendu chez 22,5% d'entre eux. Le diagnostic syndromique permet d'orienter vers la maladie rénale la plus probable et de guider les thérapeutiques urgentes en attendant les résultats de la PBR. Mais il ne peut en aucun remplacer la PBR qui reste le gold standard.

Endometrial stromal nodules are rare. They represent less than a quarter of endometrial stromal tumors. Clement and Scully described as variants of endometrial stromal nodules two types of tumor ressembling ovarian sex cord tumors. Type I is tumor that resembles focally an ovarian sex cord tumor which can be abbreviated ESTSCLE, or endometrial stromal tumors with sex cord-like elements and type II; uterine tumors with more than 40% sex cord-like differentiation so called UTROSCT for uterine tumor resembling ovarian sex cord tumor. Uterine tumours with sex cord-like differentiation are very rare with only 50 cases reported in the literature so far. The diagnostic is based on microscopic findings. Immunohistochemical tests to elucidate their nature yield variable and polyphenotypic with coexpression of markers of epithelial, myoid and sex cord lineage as well as hormone receptors. We report an additional case of an endometrial stromal tumors with sex cord-like elements in a 48-year-old woman presenting with abnormal mass. Pan African Medical Journal 2013; 14:51

Eccrine carcinoma is an extremely rare malignancy of the skin with few well documented cases reported in the literature. It is frequently found on the lower extremities, and it equally affects both sexes in the sixth and seventh decade. In our case, we present a 46- year-old female with a recurring exophytic tumor on the right lower extremity, without local extension. The initial tumor was biopsied, excised and diagnosed as an eccrine carcinoma. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3568051328673318.

Introduction. Hepatobiliary cystadenomas are rare benign cystic tumors and have a potential for recurrence and malignant transformation. The diagnosis may be very difficult because of absence of typical imaging feature in some cases.Case Presentation. In this paper, the authors discuss a 57-year-old woman who presented a jaundice related to hepatobiliary cystadenoma. Biological and radiological examinations have led to surgery, and the diagnosis is made after a histological examination of surgical specimens.Conclusion. This observation illustrates a hepatobiliary cystadenoma revealed by jaundice. Histology examination contributed to diagnosis. The authors discussed the mechanisms of biliary obstruction and differential diagnoses through a review of the literature.

Le dermatofibrosarcome de Darier et Ferrand (DFS) est une tumeur mésenchymateuse cutanée de malignité intermédiaire. C'est une tumeur rare mais non exceptionnelle, représentant 0,1% des tumeurs cutanées malignes. Les auteurs présentent une étude rétrospective de 27 cas de DFS diagnostiqués sur une durée de 7 ans (2004 à 2010) et la comparent aux données de la littérature. Cette étude permet d’établir en plus des caractéristiques anatomopathologiques et immunohistochimiques, une étude épidémiologique, clinique et évolutive de ce sarcome. l’âge moyen de nos patients est de 41 ans avec une prédominance masculine. Le tronc est la localisation préférentielle touché dans 52% des cas. La taille tumorale a atteint 30cm et mesure en moyenne 6,1 cm. Le diagnostic était évoqué à l'examen histologique standard et confirmé par l'expression intense et diffuse du CD34. Le traitement était chirurgical, associé à une radiothérapie dans 2 cas. L’évolution était marquée par la transformation en un sarcome pléomorphe de haut grade dans un cas et par la survenue de récidives locales dans 2 cas. Nos résultats sont classiques et comparables aux autres séries de la littérature. L'examen histologique est indispensable pour le diagnostic. L'exérèse chirurgicale large est le traitement de référence. Le pronostic est conditionné par une malignité surtout locale et un fort potentiel de récidive. La transformation sarcomateuse franchement maligne métastasiante est exceptionnelle.