[Atypical renal cysts]

Background: Atypical renal cysts are suspicious for malignancy. It is hard in some cases to give a sharp radiological diagnosis and propose an appropriate management

Aim: To give the histological results of the operated atypical renal cysts and to establish a correlation between the radiological findings and histological features

Methods: Between January 2001 and December 2012, 22 patients have been operated in our department for atypical renal cysts. There were 10 type III and 12 type IV Bosniak lesions. We have reported clinical, epidemiological and radiological findings. We have analyzed the histological results taking into consideration the radiological findings

Results: According to histological findings, 7 among the 10 type III lesions were benign [70%]. However, only one case of benign tumor was noted in type IV lesions [8.3%]. There was no evident correlation between tumors size and histology. With a median follow up of 48 months, three patients died because of locally advanced tumors

Conclusion: Management of atypical renal cysts remains difficult. A careful computed tomography staging is essential before treatment. Type III and type IV Bosniak cysts were malign in 30% and 91% of cases, respectively. There was no correlation between tumor size and malignancy. A nephron sparing surgery should be proposed whenever possible

[Endoscopic realignment versus delayed urethroplasty in the management of post traumatic urethral disruption: report of 30 cases]

Post traumatic posterior urethral disruption is a common condition, its treatment is controversial. To assess the long term results of endoscopic realignment compared with delayed urethroplasty, in the management of post traumatic urethral disruption. Between February 2002 and March 2009, 30 patients have been operated for post traumatic posterior urethral disruption. 20 have had a primary endoscopic realignment and 10 have had delayed urethroplasty. Analysis of the results took into consideration, the quality of micturition, the continence and the erectile function. Median follow-up was 21 months, good results were recorded in 13 patients among the group of realignment [65%]. 0f the failure cases [7], 3 underwent urethroplasty and 4 were managed by endoscopic treatment. Endoscopic realignment could avoid open surgery in 17 patients [85%]. Among the 10 patients that underwent urethroplasty, 7 patients had good results [70%]. No patient had urinary incontinence. A post operative erectile dysfunction was noted in one patient from the realignment group and two other patients from the urethroplasty group. The endoscopic urethral realignment could be used as a primary therapeutic management of post traumatic urethral disruption. It could be recommended for recent trauma, between one and two weeks, and for patients that can support exaggerated lithotomy position. Endoscopic realignment is an effective safe therapeutic mean that does not contraindicate a second-line urethroplasty

[Abrikosoff's tumor: a clinicopathologic study of nine cases]

Abrikossoff's tumour or granular cell tumor or is a benign neurogenic tumour. It is ubiquitous with the most frequently affected site is the head and neck region. To report a series of granular cell tumors and to discuss its clinicopathologic features and histogenesis. We report a series of nine cases diagnosed between January 2004 and December 2006 in the Pathology Department of the University Hospital of Sfax. We have collected the clinical aspects and we have proceeded on a pathological, cytochemical [PAS and PAS diastasis] and immunohistochemical study. Nine cases of TCG are presented: 5 females and 4 males. The median age was 33.9 years [extremes: 7 and 53 years]. All tumours were unique. The most common localization was in the head and neck region [5 cases]. The diagnosis was suspected using standard histologic criteria and confirmed by immunohistochemistry: tumour cells expressed vimentine [90%], S100 protein [100%] and neuron specifique enolase [80%]. In all cases patients were treated by excisional resection and had a benign course with no evidence of recurrence [median follow up: 2 years]. Granular cell tumours are rare neoplasm which must be recognised because they demonstrate a benign behaviour after their surgical excision. Histological features of granular cell tumours are commonly characteristic but some times they can be misdiagnosed as malignant tumours especially when the biopsy is superficial. The staining for neurogen markers and PAS are useful tools

Cerebral gliosarcoma: clinico-pathologic study of 8 cases

Gliosarcomas are biphasic neoplasms composed of a glioblastoma admixed to a sarcomatous component with different lines of differentiation. Histogenesis of these tumors is still discussed. Our objective is to specify clinical and pathological characteristics of this rare noeoplasm and to discuss its histogenesis. Retrospective study of eight cases of gliosarcomas diagnosed between January 1998 and December 2004. Clinical, radiological, therapeutic and follow-up data were reviewed. Histological features and immunohistochemical results were also included in this review. Five patients were male, three women with a median age of 50.7 [range 31-74 years]. Symptoms were dominated by intracranial hypertension and paralysis. The most conmon location was parietal or temporo-parietal [5 cases: 62.5%]. Pathological exam including histochemical and immunohistochemical study confirmed the diagnosis of gliosarcoma in all cases. Sarcomatous component had features of fibrosarcoma in 5 cases, osteosarcoma in 2 cases and malignant fibrous histiocytoma in 1 case. All patients were treated by surgical excision [complete in five cases and partial in three cases]. Adjuvant radiotherapy was received in three cases. One patient was lost on follow-up. Two patients died from postoperative complications and the five remaining patients died with a medium follow up of 9 months [extremes: 2-24 months]. Clinical, radiological and follow-up features of gliosarcomas share great similarities with glioblastomas. Histopathological, histochemical and inmmnohistochemical studies are helpful in accuracy diagnosis. Recent cytogenetic and molecular data support a monoclonal origin for these tumors

[Histological features of celiac disease in south Tunisia: a study of 114 paediatric cases]

To report the histological features of celiac disease in a paediatric population originating from south Tunisia. A retrospective study of a series of duodenal biopsies from 114 children with celiac disease diagnosed over a period of 6 years [from January 1999 to December 2004]. The diagnosis was confirmed by histological results, serological studies and clinical response to gluten free diet. The average age of patients was of 6.2 years [range 6 months-15 years]. Sex ratio was 0.71. Symptoms were dominated by chronic diarrhea [48%], weight loss [50%] and anemia [20.1%]. Histological findings showed an intraepithelial lymphocytosis [Marsh type 1] in 12.2% of cases, type 2 was present in 1.7% of cases and type 3 [villous atrophy] in 86% of cases. A treatment with a gluten-free diet was indicated for all patients, only the cases who haven't presented a clinical amelioration [11 cases] have beneficed a control biopsie; a villous atrophy was persistent in 80% of this patients. Histological features in duodenal biopsies for the diagnosis and the follow-up of patients with coeliac disease. This allows an appropriate treatment and prevents further complications

[Central neurocytoma: a study of five cases]

Central neurocytoma is a very rare brain tumour recently described. The diagnosis rests on the data provided by anatomopathological examination and immunohistochemestry. We report a retrospective study of five cases of neurocytoma diagnosed in the Pathological laboratories of Anatomy and Cytology of Habib Bourguiba and Fattouma Bourguiba Hospitals over a period of two years [1999/2000]; this study was based on clinical, radiological and anatomopathological data. It was about three women and two men with an average age of 29 years [17 to 49 years] The tumor was located in the side ventricles in three cases. Two differential diagnoses were often discussed: oligodendroglioma and ependymoma. Immunohistochemistry showed an expression of the synaptophysine in every case. The treatment was exclusively surgical and the course was favorable with an average follow up of 48 months; only one case of relapse was noted of 36 months after the diagnosis