[Primary tuberculosis of the gallbladder]

It is a very rare affection even in our country which is a tuberculous endemic country. The physipathological mechanism is still controversial, lithiasis plays a role in supporting the tuberculous localization in the gallbladder which decreases the vesicular resistance against bacillus of Koch. It is about a case of tuberculosis of the gallbladder of an operated patient for chronic lithiasis cholecystitis which appears to have a direct relation with the vesicular lithiasis. Its diagnosis depends on the histological examination of the piece of cholecystoctomy. This pathology represents 1% of the digestive turberculosis localization. Its clinical signs are not specific. The biological assessment shown the presence of blooc lymphocytosis which is in favor of a possible tuberculosis, but rarely found. The only certitude diagnosis is the anatomopathological examination of the excised piece of cholecystoctoy by finding the evidence of the epitheloidal and granulomatous inflammation and cellular overgrowth with caseous necrosis. The physiopathological mechanism is still discussed. The presence of calculus resulting in disappearance of biliary acids and provokes a non specific inflammatory reaction to the vesicular mucosa which decreases the vesicular resistance against bacillus of Koch. This possibility shows an increase in frequency in the developed countries due to the emerging of AIDS. The impact of the lithiasis on the appearance of this specific inflammation is possible but remains discussed. Its treatment is medico-surgical

[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