[ rare pelvic hydatid cyst]

Pelvic localization of hydatid cyst is uncommon even in endemic countries such as Tunisia. Localization in the broad ligament represents only 0.3% of cases. A 22 year's old woman had consulted for a pelvic pain operating for a month. An abdominal ultrasound had found a compartmentalized cystic formation of 145mm lateralized to the left. The surgical exploration had found a hydatid cyst of the left broad ligament, which was resected. Hydatid cyst of the broad ligament remains extremely rare, treatment is surgical and is the only guarantee of a disease free survival

[Breast cancer in Tunisia: epidemiologic characteristics and trends in incidence]

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry [NTCR] and from the Salah AZAIZ Institute [SAI] Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases / 100, 000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years [11%] could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia

[Radio-histological correlation of the microcalcifications of the breast: Tunisian center experience]

Evaluation of surgical biopsy for mammary microcalcifications, in Tunisian patients according to the American College of Radiology's recommandations [ACR]. 100 patients treated in Salah Azaiez Institute from January 2005 to December 2006, who underwent surgical biopsy for breast microcalcifications. The diagnosis was based on mammography associated in 60% of the cases, to ultra-sonography. We correlated biopsies results to ACR classification. 123 surgical biopsies are related to ACR 3 lesions in 72 cases [58, 5%] ACR 4 in 39 cases [32%] and ACR 5 in 4 case [11, 5%]. The histological examination showed malignant lesions in 4 cas/72 ACR3 [5, 5%], 19/39 ACR4 [48, 7%] and 10 among the ACR5 [71, 4%]. Our preliminary study introduces a diagnostic approach of mammary microcalcifications that are usually infra-clinic lesions, in a general context of breast tumors detected with an average size of more than 3cm

[Conservative treatment of breast cancer - study of 160 cases]

To study the impact of conservative treatment of the breast cancer on overall survival and recurrence free survival and trying to determine the prognostic factors. With a retrospective study over a period of six years [1995 to 2000], about 160 patients diagnosed and treated in Salah Azaiz Institute for early breast cancer. Only 9% of patients had a breast conserving therapy for breast cancer. The mean age was 47 years. The most frequent motive of consultation was breast nodule. The tumour was located in the upper outer quadrant in 43% of the cases. Local excision of the tumour with re excision of the tumour bed associated with lymph node dissection were performed in all patients. Invasive ductal carcinoma was found in 83% of the cases, grade I in 23% of the cases and grade III in 32% of the cases. On the other hand, 35.4% of the removed axillary lymph nodes were involved. Hormone receptors were positive in 61% of the tumours. The follow up of the patients was from 18 to 98 months with a mean period of 55 months. The 5 year overall survival was 92% with recurrence free survival of 94%. The recurrence rate was 3.7% within a period of 5 to 60 months. The 5 year metastases free survival was 82% with metastases rate of 10%. The most frequent localization was the bone [43.5%]. The mean delay of metastases went from 11 to 62 months. The univariate study of prognostic factors showed that histological tumour size had a significant impact on metastases free survival. The invariant study of the prognostic factors on overall survival showed that the tumour size < 3 cm, the absence of the lymph node involvement [P = 0.02], positive hormone receptors [P=0.02] represented good prognostic factors. The rate of conserving therapy remains low in our country, and this is because of the importance of the tumour size at the diagnosis, with survival rate and locoregional recurrence rates similar to the literature data. The augmentation of the number of the patients that can benefit with conserving therapy must imperatively pass through the development and the promotion of early diagnosis and screening by mammography

[Mixed mullerian tumors of uterus - about 25 cases]

The malignant mixed mullerian tumours [MMMT] or carcinosarcoma of the uterus are rare tumours, they represent 1,4% of all uterine neoplasia. They are characterized historically by double components carcinomatous and sarcomatous. We performed a retrospective study about 25 cases of carcinosarcoma of the endometrium, collected in Salah Azaiz Institute over a period of 30 years going from 1970 to 2000. The mean patient age was 60 years, and 68% of patients were menopaused. The metrorrhagia was revealing in 66% of cases. Clinically, an abdominopelvic mass was found in 12% of the cases. The pathological diagnosis was done in 12 endometrial biopsies and 10 biopsies of the tumour exteriorisated by the cervix. Surgery is the mainstay of the treatment. The prognosis remains dismal

[Non functional paraganglioma of the organ of Zuckerkandl a case report]

We report a case of non secreting retroperitoneal paraganglioma which developed on the organ of Zuckerkandl in a 28-years-old woman. Paraganglioma is a rare tumor of the paraganglionar system arising from undifferentiated cells of the neural crest. The originality of our observation comes from the non-secreting character of the tumor and rarity of this location

[Elastofibroma dorsi about one case and review of the literature]

Elastofibroanas are rare benign soft tissue tumours that are almost always located at the inferior pole of the scapula, deep to the serrains anterior muscle, Their anatomical location, a distinctive clinical symptom and radiological particularities distinguish them from malignant soft tissue tumours. We report a case of a 48 years old man who had presented an under scapular mass. Clinical exam found a 70 mm mobile mass. CT scan showed a soft tissue neoplasm deep to the peri-scapular muscles. We processed to a total excision of this mass. Histological study showed an elastofibroma

[Malakoplakia of the bladder: a cases report and review of the literature about a cases report]

Malakoplakia is an uncommon granulomatous response to chronic urinary tract infections which may mimic malignancy radiologically and/or endoscopically. The diagnosis is made on histological examination. The treatment is based on antibiotherapy associated with histological drugs. The surgical treatment is indicated when the organ is severely damaged. We report a ease of malakoplakia of the bladder in a 45 years old man

[Clinicopathological characteristics of synchronous bilateral breast carcinomas. Report of 30 patients]

The objective of this study is to determine the clinicopathologic characteristics; incidence and prognosis value of synchronous bilateral breast carcinoma [SBBC]. This is a retrospective study done in Salah Azaiz Institute of Tunis about 30 patients with synchronous bilateral breast carcinomas diagnosed and treated over a 21-years period going from 1977 to 1997. The definition of synchronous breast lesions is the development of the contralateral breast cancer within 6 months. Median age was 49 years. The incidence of SBBC was 0.52%. History family was noted in 3% of our population. Mean tumor size was 40 mm [15-145]. Breast conserving therapy was done in 16% of cases [9 patients]. Five-year overall survival was 40%. Five year survival rates were 72 and 17% for stage II and III, respectively. Main prognostic factors for survival were lymph node involvement [P=0.004] and disease stage [P=0.02]. Synchronous bilateral breast carcinoma is a rare entity, with a problem of definition concerning the delay of bilaterlisation. Their prognosis is similar to that of unilateral breast carcinoma patients of equal stage. Hence, breast conserving therapy can be used safely if indicated

Cardiac metastasis of leg liposarcoma. A case report

Cardiac tumors are rare. In autopsic series, their incidence is 0.02 - 0.03%. Liposarcoma is an exceptionnel cause of cardiac metastasis. We report the case of a 55 years old patient, operated for multiple localisations of liposarcoma [left leg, left arm, abdomen]. As well as, he has a vertebral metastasis treated by radiotherapy. Two months later, the patient consulted for dyspnoea. A cardiac ultrasound tomography showed dilated right cavities with a volumineous intra ventricular mass. A thoracic computed tomography was showed a tissular intracardiac mass. The patient was operated in a cardiovascular surgery service, but died in post operative period. The purpose of this study is to specify the cardiac metastasis incidence, the diagnostic methods and therapic modalities

Basal cell carcinoma of the vulva. Case report and review of the literature

Basal cell carcinoma [BCC] accounts for 2 to 3% of all vulvar malignancies and for less than 1% of all BCC. More than 250 cases of vulvar BCC have been reported in the literature. Clinical, pathological and follow up data are similar to results in the present series. Treatment of choice consists of surgical excision with tumor-free margins. Because of local recurrence risk and possible association with other primary cancers in this age group, long term follow-up is necessary. We report a case of BCC of the vulva occurring in a 60 years old woman

[Embryonal rhabdomyosarcoma of the uterine cervix - a case report

Rhabdomyosarcoma of the uterine cervix is an uncommon highly malignant tumour. It usually presents in the adolescent age group. Only 4 cases of rhabdomyosarcoma of the uterine cervix had been reported in women in perimenopausal. Treatment had evolved since new chemotherapy protocols and better classification has been established by the Intergroup Rhabdomyosarcoma Study. One case of Embryonal rhabdomyosarcoma of the uterine cervix is reported in a 47 years woman. She was treated with surgery and external radiotherapy. After 12 months, no signs of recurrence are reported

[Pseudo tumoral splenic tuberculosis - a case report]

Splenic tuberculosis is uncommon. It is reported in disseminated tuberculosis syndrome and can be a symptom of AIDS. Pseudo tumoral forms are rare. Diagnosis is difficult on the basis of the clinical and radiological presentation. Histological analysis confirms the diagnosis. We report the case of a 30 years old women treated for nodal tuberculosis. After 4 months of treatment, she consulted for non specific abdominal pain without other signs. Radiological exploration concluded for nodular spleen lesions. The patient had gone under a median laparotomy and a splenectomy was performed for multiple abscess in the spleen. Pathological exam of the spleen confirm that it was splenic tuberculosis

[Degenerated perianal giant acuminatum condyloma. About 2 cases]

The Giant condyloma acuminatum [GCA] is a rare cutaneous tumour, of sexual viral transmission origin, especially reaching perianal zones. We report the cases of two men who present perianal GCA treated at the surgical oncology unit of Salah Azaiz Institute. Diagnosis of degeneration was made before the treatment in the two cases. Treatment was surgical. With a follow up of 3 and 15 years, there are no signs of recurrence