Performance des explorations cliniques et de l'échographie mammaire dans le diagnostic des tumeurs bénignes du sein en milieu peu équipé d'Afrique subsaharienne / Performance of clinical investigations and breast ultrasound in the diagnosis of benign breast tumors in low-resource settings in sub-Saharan Africa

Contexte et objectif. Malgré leur fréquence élevée, très peu d'études ont été menées sur les tumeurs bénignes du sein (TBS) en Afrique subsaharienne. L'objectif de la présente étude a été d'évaluer la valeur diagnostique des explorations clinique et échographique mammaire des TBS en milieu peu équipé. Méthodes. Il s'agissait d'une étude documentaire, sur les TBS suivies aux Cliniques Universitaires de Kinshasa, entre janvier 2016 et décembre 2021. La valeur diagnostique des explorations clinique et échographique mammaire des TBS (sensibilité, spécificité, valeur prédictive négative VPN, VPP, coefficient Kappa) a été calculée en prenant pour référence la découverte anatomopathologique des pièces biopsiques. Résultats. Au total, 81 dossiers de TBS ont été colligés. Le Fibroadénome 58 (71,6 %), la Maladie fibrokystique (MFK) 15 (18,5 %), l'Adénome tubuleux 6(7,4 %), la Tumeur Phyllode (TP) 1(1,2 %) et le kyste 1(1,2 %) étaient les tumeurs diagnostiquées à l'anatomopathologie, après tumorectomies. A l'examen clinique, la capacité diagnostique des TBS autres que le Fibroadénome était nulle. La spécificité, la VPN et le coefficient kappa étaient respectivement, de 60,0 %, 39,1 % et 32,2 % pour le diagnostic du Fibroadénome. L'échographie mammaire était faite dans 98,6 % tandis que la mammographie seulement dans 11,1 % des cas. La majorité des tumeurs étaient classées Breast Imaging reporting and Data system (BIRADS) 2 (70,0 %). La spécificité, la VPN et le coefficient kappa étaient respectivement, de 80,6 %, 40,9 % et 39,0 % pour le Fibroadénome, et de 84,4 %, 66,7 % et 1,9 % pour la MFK. La TP était classée BIRADS3. Conclusion. L'échographie mammaire très réalisée, est très performante dans la classification BIRADS des TBS; les cliniciens exerçant en milieu peu équipé peuvent donc sans équivoque suivre les recommandations sur la prise en charge des tumeurs classées BIRADS2 et BIRADS3 à l'échographie, bien que sa performance en ce qui concerne le diagnostic différentiel de ces tumeurs soit moindre.

Les tumeurs intraventriculaires de l'encephale

Objectif Rapporter notre experience des tumeurs intraventriculaires encephaliques Methodes Etude retrospective descriptive et analytique portant sur une serie de 19 patients traites de Janvier 1994 a decembre 2004. L'evaluatio n diagnostique s'est faite a l'aide de la tomodensitometrie cranio-encephalique et de l'etude neuro-pathologique des pieces operatoires. Les tumeurs paraventriculaires prolabees dans les ventricules ont ete exclus. RESULTATS : Il s'agissait de 12 patients de sexe masculin et 7 de sexe feminin (sex ratio: 1.71). L'age moyen des patients a ete de 19 ans variant entre 2 et 52 ans avec un pic de frequence entre 20 et 29 ans. Le syndrome d'hypertension intracranienne a ete la circonstance diagnostique la plus frequente (89.4) et l'hydrocephalie presente chez 78.95des patients. La tomodensitometrie cranio-encephalique a ete realisee dans tous les cas. Les ventricules lateraux ont ete le site anatomique le plus touche (52.63) suivi du troisieme ventricule (26.32) puis du quatrieme ventricule (21.05). L'evaluation de la qualite de l'exerese tumorale a montre 61.11d'exerese complete contre 38.89d'exerese partielle. D'un point de vue neuropathologique l'Ependymome a ete la tumeur la plus frequente (21.05) et la majorite des tumeurs etait benigne ou a faible potentiel evolutif. La mortalite globale liee aux tumeurs intraventriculaires a ete de 21.04(4 cas) avec une mortalite operatoire a 10.52(2 cas). Conclusion Ce travail portant sur les tumeurs intraventriculaires dans leur ensemble semble etre le premier effectue en Afrique subsaharienne. Malgre leur siege ces tumeurs sont souvent curables lorsque le diagnostic est pose precocement. L'exerese tumorale complete doit etre tentee autant que possible

Ophthalmic Manifestations in Patients with Intracranial Tumours

Background: This study was aimed at determining the ophthalmic manifestations of patients presenting with brain tumours in a Nigerian tertiary hospital. Method: A retrospective crossectional review of patients with brain tumors in the Neurosurgical Unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife from January 2003 to December 2007 was conducted. Data on biodata, source of referral, diagnosis, visual acuity at presentation and management were recorded and analyzed for simple frequency using the SPSS version 11. Visual acuity was classified using the WHO classification for presenting acuity in the better eye. Results: Out of a total of 94 patients, 88 with complete information were reviewed. There were 53 [60.2%] males and 35 [39.8%] females; the mean age was 36.2±20 years. Fourteen [15.9%] patients were referred by Ophthalmologists. Meningiomas(36.4%), craniopharyngioma(13.6%) and gliomas(9.1%) were the most common brain tumours encountered. Fifty nine(67.9%) had visual complains at presentation; poor vision (46.6%) and double vision (12.5%) were the most common ocular symptoms while opticatrophy was the commonest ocular sign (23.9%). 46 (52%) %) were blind while 14(16%) had visual impairment. Patients with visual impairment and blindness were more likely to have visual complains at presentation (88.3%) compared with 50% amongst patients with normal vision (P=0.003). Conclusion: Ophthalmic signs and symptoms form a major part of presentation in patients with intracranial tumours. Health education and complete ophthalmic evaluation is essential in patients with brain tumours

The neuropsychiatry of brain tumours

Every psychiatrist who has worked in the clinical field for some time will be able to relate a story of a patient who presented with psychiatric symptoms but eventually turned out to have a brain tumour. We all fear that someday we will misdiagnose a brain tumour and therefore fail to save a patient's life. The purpose of this article is to give a brief outline of the important clinical issues related to brain tumours and psychiatry

Morphological Pattern and Frequency of Intracranial Meningioma in Tanzania

Objective: The objective of the study was to study the histological pattern of intracranial meningiomas; provide a comprehensive data about its frequency in both adults and children and to correlate the site of the tumour with histological diagnosis. Design: A descriptive study. Place and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998 to October 2004). Patients and methods :The histopathological data of 54 intracranial meningiomas of adults and children was evaluated on H et E stained sections of paraffin embedded tissue. Results: The ages ranged from 6 to 87 years with mean of 36.6 years. The male to female ratio was 1:1. All histological subtypes of meningiomas were in WHO grade I category and meningotheliomatous type comprised the largest subtype (37). Others were transitional (25.9); fibroblastic (22.2); angiomatous (7.4); psamommatous (5.6) and microcystic (1.9). Out of 54 meningiomas; 43 (79.6) were supratentorial and 11 (20.4) were infratentorial in location. Meningotheliomatous meningioma was the commonest histological subtype in supratentorial region (41.9) while in infratentorial region fibroblastic and transitional subtypes were the commonest (36.4each). Conclusion: All meningioma were in WHO grade I category and meningotheliomatous was the commonest overall and also the most predominant in the supratentorial region while in infratentorial location transitional and fibroblastic subtypes were the commonest with equal frequency. Meningioma gave an equal gender ratio in our study

Morphological Pattern and Frequency of Intacranial Tumours in Adults and Children in Tanzania

Objective: The objective of the present study was to study the histopathological pattern of intracranial tumours and to provide a comprehensive data about their frequency in adults and children less than 16 years and to correlate the site with histological diagnosis.Design: A descriptive studyPlace and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998- October 2004).Patients and Methods: The histopathological data of 104 brain tumours of all adults and children less than 16 years histopathologically evaluated was performed on H et E stained sections of paraffin embedded tissue. Special stains were performed whenever indicated.Results: The ages ranged from 2 to 90 years with an overall mean of 34.4 years while that of children below 16 years was 9.5 years and in adults was 41.9 years. The male to female ratio was 1.2:1. Meningiomas comprised the largest category (51.9) and Glial tumours ranked the second (21.4) of primary brain tumours and among all gliomas astrocytomas were the commonest comprising of 16.4 of all intracranial neoplasms. Out of 104 brain tumours; 83(79.8) were supratentorial and 21(20.2) were infratentorial in location while in adults 72(84.7) were in supratentorial region and 13(15.3) were in infratentorial region. In children below 16 years; 11(57.9) and 8(42.1) were in supratentorial and infratentorial in location respectively. The most common tumour overall in both supratentorial and infratentiorial regions were meningiomas (53) and all were in WHO grade I. When age was taken in consideration; meningiomas remained the commonest supratentorial tumours in adult (56.9) while in children below 16 years; cranioparyngioma was the commonest supratentorial neoplasm (45.4). In children less than 16 years medulloblastoma and pilocytic astrocytoma were the commonest neoplasms in the infratentorial region (37.5 of each).Conclusion: Meningioma was the commonest intracranial tumour overall in both supratentorial and infratentorial locations. However medulloblastoma and pilocytic astrocytoma were the most common tumours in the infratentorial region in children below 16 years of age