[Multiple myeloma in young patients]

Multiple myeloma is the most common type of malignant hemopathy, affecting mainly the elderly; the occurrence in adolescents and young adults remains exceptional. This is a 5-year retrospective study conducted at the Hematology Laboratory of the CHU Hassan II in Fez, including 13 patients with multiple myeloma whose age is less than or equal to 40 years. The average age of patients is 35.5 years, with a male predominance. The clinical signs are dominated by bone signs. The biological assessment shows a monoclonal gamma peak in 60% of cases, and renal failure in 38% of cases. Sternal puncture showed plasma cell infiltration in 30% of cases. 45% of the patients were treated by CDT, 55% by VDT, with good progress in 30% of cases over an average of 60 months. This study shows that myeloma in young people is marked by its clinical severity, but the therapeutic advances made it possible to improve the prognosis of the patients

[B cell prolymphocytic leukemia with poor prognosis]

B cell prolymphocytic leukemia is a rare disease with poor prognosis compared with chronic lymphocytic leukemia. Patient aged 75 years old, diabetic and hypertensive, with a massive splenomegaly associated with leukocytosis exceeding 100000/mm3 predominantly prolymphocytic, invading the bone marrow. Immunophenotyping showed CD19 +, CD20 +, CD22 +, CD5 part, CD23+ CD79b + FMC7 stronger and stronger, Smg + in vafour for a type B-cell prolymphocytic leukemia. The evolution was rapidly unfavorable despite an first line treatment of eight cycles of COP [cyclophosphamide, vincristine and prednisone]. Partial remission was short, followed by the reappearance of the splanomegaly, new increase in the of Prolymphocyte tate with thrombocytopenia and profound anemia. The patient had received two courses of Fludarabine. Dath occurred after eighteen months of follow up due to a state of septic shock and tumor lysis syndrome. This malignancy accounts for 2% of all chronic lymphocytic leukemia with 80% phenotype B. It frequently affects patients of 70 years old with a clear male predominance. The prognosis is more severe than that of chronic lymphocytic leukemia. Anemia <11g/dl and lymphocytosis > 100000/mm3 are the factors of poor prognosis. The median survival was 65 months reported by Shvidel et al. in a series of 35 observations. Promising results are reported with new treatments. The antibady anti-CD20 has been used successfully for the second type of B-cell prolymphocytic leukemia after relapse. The allograft or autograft are indicated, but it is mostly used in patients, who have contraindications to a heavy treatment

[Basal cell carcinoma of the parotid gland]

Basal cell carcinoma is a rare tumor mainly affecting major salivary glands, it's a low grade malignancy with cytological features of a basal cell adenoma but whose evolution indicates malignancy. We report the case of a 30 years old woman, who presented two years ago with a right parotid swelling gradually increasing. The computed tomographies [CT] show an ulcerative infiltrating tumor in the parotid gland extending locoregional lymph nodes. The evolution was marked by ulceration of the skin overlying the cervical lymph node with magma. The diagnosis was made on biopsy sample using morphological study, immunohistochemistry and radiological data. This tumor presents problems of differential diagnosis mainly with basal cell adenoma of the parotid gland. The high number of mitoses and infiltrative character on CT allowed to retain that diagnosis. Surgical treatment is sometimes coupled with adjuvant radiotherapy. The evolution is marked by frequent recurrences with rare metastasis. Basal cell carcinoma is usually of good prognosis and its diagnosis is histopathological

[Mammary hamartoma]

Mammary hamartomas are uncommon benign lesions. The reported incidence of breast hamartomas is 0.7% of benign breast tumors in female. In this paper, we report a case of breast hamartoma emphasizing the role of the pathologist in remaining this diagnosis. A 37 years old women, presented with a voluminous lump of the breast with mastodynia. On clinical examination, the lump was in the external quadrants of the right breast measuring 7 cm in the great diameter with no controlateral or axillary abnormalities. Ultrasound examination and mammography showed an ACR3 tissular heterogenic mass suggesting the diagnosis of phyllode tumor or hamartoma. On needle core biopsy the diagnosis was favor a mammary hamartoma associated to a proliferative mastopathy. The mass was excised and the histologic examination confirmed the initial diagnosis according to the clinico-radiologic context associated with mastosis. Epithelial changes and mastosis may be seen within the hamartoma and should be reported. On the other hand, although hamartomas are benign, coincidental malignancy can occur, thus, adequate sampling of mammary hamartoma is essential. Mammary hamartomas are uncommon benign lesions that are probably underestimated because of lacking of specific diagnostic criteria. Correlation with the imaging findings and clinical impression is necessary to retain this diagnosis. The treatment is surgical lumpectomy and the prognosis is good

[Hepatoid carcinoma of the ovary]

Hepatoid carcinoma is a primary malignant extrahepatic tumor that arises outside the liver and resembles hepatocellular carcinoma both histologically and immunohistochemically in its staining for alphafoetoprotein. It's a very rare tumor described in the ovary, the lung, the stomach, the kidney and the bladder. It is seen especially at the sixth decade. We report a case of a 73-years-old woman followed since 2008 for a poorly differentiated carcinoma of the left ovary treated surgically. In the absence of adjuvant therapy, she presented one year later, with a necrotic lomb-aortic mass and an increased level of CA125 [188 u/mm]. After three [3] courses of chemotherapy, the disease progressed rapidly with resumption of tumoral syndrome and bone metastases. The case was reviewed at our institution and implemented by an immunohistochemistry analysis. The diagnosis of hepatoid carcinoma of the ovary was therefore retained. This entity was first described by Ishikura and Scull in 1987. hepatoid carcinoma was reported 18 times in the ovary. The clinical and radiological signs are not specific. Biology can guide diagnosis with elevated serum AFP. The diagnosis is pathological. The differential diagnosis include ovarian metastasis of hepatocellular carcinoma and hepatoid yolk sac tumor. Differentiating the tumor is primordial and critical, because treatment modalities depend on the exact nature of the hepatoid cancer

[Adenoid cystic carcinoma of the cervix]

Adenoid cystic carcinoma is a malignant neoplasm described in the salivary glands. Primary adenoid cystic carcinoma of the cervix is extremely rare, accounting for less than 1% of all cervical carcinomas. A 54 years old woman presented with the complaints of vaginal bleeding and pain. The cervical examination revealed a polypoid swelling mass measuring 1.5 cm in great dimension. A cervical biopsy diagnosed an adenoid cystic carcinoma associated with cervical intraepithelial neoplasia grade III [CIN III]. After a brachytherapy, the patient went through a radical surgery. The pathological study of the specimen confirmed the initial diagnosis. Adenoid cystic carcinoma is more common in the salivary glands and respiratory tract glands. Exceptionally, it may arise in the cervix. An accurate diagnosis is exclusively established by pathology. The histological appearance is similar to its counterpart in salivary glands .the characteristic cystic spaces are filled with a slightly eosinophilic hyaline material or basophilic mucin and are surrounded by palisaded epithelial cells. The most important differential diagnosis of cervical adenoid cystic carcinoma is ademoid basal carcinoma which has a better prognosis. Adenoid cystic carcinoma of the cervix is an uncommon neoplasm. Histological examination is necessary to confirm this diagnosis. The optimal treatment combines surgery and radiotherapy associated to chemotherapy. The prognosis remains poor

[Immune thrombocytopenic purpura]

It is characterized by a low platelet count < 150000/mm[3], which is the result of both increased platelet destruction and insufficient platelet production. In this paper, we will focus on current aspects of geoepidemiology, pathophysiology, diagnosis and management of primary immune thrombocytopenia in adult. The development of autoantibodies against platelet glycoproteins remains central in the pathophysiology of immune thrombocytopenic purpura, several abnormalities involving the cellular mechanisms of immune modulation have been identified. The goal treatment is to raise the platelet count to high enough levels to prevent bleeding. Corticosteroids, intravenous immune globulin, and splenectomy remain mainstays of treatment; however, newer therapies including rituximab and the thrombopoietin receptor agonists are remodeling conventional treatment algorithms. Effective treatments are aimed at different steps in the pathophysiologic process including the reduction of autoantibody production, interference with FcR uptake and signaling, suppression of B and T cells, and increase in TPO activity. The development of biologic therapies, particularly anti-CD20 and the emergence of new drug to increase platelet production rather than modulating the immune response, however, may radically change the management of immune thrombocytopenic purpura and make the information rarest of splenectomy

[Aggressive evolution of dermatofibrosarcoma]

Malignen change in dermatofibrosarcoma protuberans is a rare phenomenon. We present one case. A patient operated for local recurrences of dermatofibrosarcoma. The histopathological study showed a fascicular and highly cellular histological pattern in the dermis, with important mitotic activity. Sometimes the nucleus was central chow small indentations produced by multiple small vacuoles like a lipoblast, with an extensive capillary network appearance the diagnosis of liposarcoma was proposed. Malignen change of dermatofibrosarcoma is defined by it herringbone architecture, hypercellularity, and increased mitotic rate. Occasionally, can lead to misdiagnosis with other spindle-cell tumors especially liposarcoma which has a worse prognosis. Multiple sampling and immunohistochemistry with antibody CD34 help to establish the right diagnosis. The degree of aggression is related to the histological grade and of sarc omatous transformation. The prognosis of the transformed dermatofibrosarcoma is more aggressive than the classic than one in liposarcoma

[Imaging and pathological discordance in breast tumours]

Phyllode sarcoma is a rare lesion. Its epithelial component is usually benign and the mesenchymal component can differentiate into liposarcoma. These tumor has clinical and radiological characters of the benign lesions. But only the histological examination can diagnose and evaluate its prognosis. Carcinosarcoma of the breast results from a dedifferentiation of the invasive epithelial component found in the liposarcoma. The aim of our observation is to emphasize the clinical, radiological and the anatomo pathological discordances of these tumors and to underline the importance of the anatomopathological finding in its diagnosis and its impact on treatment. She is a 17-year-old girl, who has since one year a left breast lump and, after excision, a fast recurrence occurred. Echographic picture was in favour of a fibroadenoma. The tumour was diagnosed as a possible phyllode tumour. The histopathological and the immunochemistry findings proposed three diagnosis: a phyllod sarcoma with a heterogonous liposarcomatous stroma, a liposarcoma associated with an itracananicular carcinomas, carcinosarcoma with invasive differentiated carcinomatous components in a liposarcoma. Although physical and radiological examinations were in favour of a benign tumour, the anatomo pathological analysis proved the malignant nature of the tumour, and invited the surgeons to deal with the case as a carcinosarcoma due to its bad prognosis. Pathological analysis is therefore mandatory for diagnosis and the choice of treatment since, in our case, an aggressive treatment is necessary instead of a conservative one if the diagnosis of fibroadenoma was retained

Role of pathology in nasopharyngeal cancer

Nasopharyngeal cancers account for 45% of all ear -nose and throat cancers at the National Institute of Oncology [cancer registry]. Carcinomas are by far the most frequent with the particularity of being tightly linked to the presence of Epstein-barr virus, sensitive to radiation therapy and lymphophilic revealed by cervical masses in 40% of the cases. A precise and reliable anatomo pathological diagnosis is therefore manasatory before intiating any treatment. Methods and The authors report the results of histopathologic techniques [routine and special stains immunohistochemistry] in the diagnosis of 143 biopsies of the rhinopharynx with a frequency of undifferentiated carcinoma of the nasopharynx [UCNT]. All biopsies of suspicion of relapse were inflammatory corresponding to mycotic inflammation in half of the cases. A special emphasis is made on the conclusive contribution of in situ hybridization on paraffin sections in positive and differential diagnosis with regard to the results described in the litterature. Therefore, in the particular context of nasopharynx cancer-frequent in our country, sensitive to radiation therapy but with possible relapses-, the authors emphasise on the specific utility, besides basic and special stainings and immunohistochemistry, of in stiu hybridization of paraffin sections, to search for the presence of Epstein-barr virus particles in tumoral cells. This technique should, indeed, be used as reliable routine technique allowing positive diagnosis of relapses and differential diagnosis in the cases of cervical masses without a known primary site and an extensive cancer of the rhinopharyngeal and sinonasal regions

HPV typing and cervical cancer screening: results of Moroccan critical study

Cancer of the uterine cervix, the second most frequent cancer after breast cancer in Morocco, is closely linked to several types of Human Papilloma Virus [HPV] especially the potentially oncogenic types 16 and 18 mostly found in high grade precancerous lesions and uterine cervix cancer. In the Bethesda cytological classification, HPV infection and Cervical Intraepithelial Neoplasia grade I [CIN 1] are classified as Low grade Squamous Intraepithelial Lesions [LSIL] whereas CIN 2 and CIN 3 are considered High grade Squamous Intraepithelial Lesions [HSIL]. The cytologic diagnosis of HPV infection on cervical Pap smears relies on the association of several criteria of which koilocytosis is considered specific of HPV infection. Colposcopy and direct biopsies are therefore necessary to cofirm the diagnosis. Nevertheless, since the introduction of HPV typing in uterine cervix cancer screening, koilocytosis is disregarded as a necessary criteria for the diagnosis of HPV infection. The authors report the results of a study which corroborate this statement and correlate histopathology and HPV typing of benign lesions collected at our institution [INO]. Guidelines for follow-up are also discussed according to the data in the literature

Gliomatose peritoneale avec metastase ganglionnaire associe a un teratome ovarien: [a propos d'un cas]

In rare cases, the peritoneal surfaces can host metastatic mature glial cells which are supposed to derive from the neuroectodermic component of ovarian teratoma after capsule rupture. This entity rises questioning about its histogenesis and its prognostic significance. We report a case of a 19 years old young woman who had surgery for an ovarian teratoma with adult and immature components [grade I of Thurbeck et Scully classification] with gliomatosis peritonei and lymph node metastasis. The patient has had chemotherapy and currently has a good evolution. Maturation of peritoneal implants could be secondary to hypoxia either spontaneously or after a chemotherapy. It was also reported that cells of mononuclear and phagocytic system can promote in vitro proliferation or differentiation of astrocytes. The good prognosis of gliomatosis peritonei is nevertheless dependent of a long clinical follow-up and a rigourous histologic examination of peritoneal surfaces since malignant transformation can occur many years later

Controle spectroscopique infrarouge de la des produits et colorants utilise's en anatomic-pathologique

Our study is about an easy method employing infra-red spectroscopy control of chemical products used in big amounts in pathology laboratories

Modifications morphologiques, Immunohistochimiques et structurales chez la rat des sables marocains sous re'gime hypercalorique

Our study was performed on 66 sand rats living in Morocco [Psammomys obesus] a specimen which is predisposed to develop obesity and diabetes type II when given a hypercaloric diet instead of its natural diet [chenopodiacees]. Nine months after the hypercaloric diet, we observed different types of injuries especially microangiopathies associated to other microscopic, immunohistochemical and ultrastructural alterations. These results are correlated to the biochemical findings. [Glycemy, lipidic metabolism and insulin dosage]