[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

Idiopathic granulomatous mastitis

The idiopathic granulomatous mastitis is a rare entity. Up till now there is no any theory that can explain this pathology, specially the auto-immune origin. So we can consider it as of unknown aetiology. It is often adopt a cancerous radio-clinical semiology, while the histological examination proves that it is of a benign nature. Its diagnosis depends on a multidisciplinary approach. It is of an exclusion diagnosis, which needs an adequate treatment, with a long course follow up. We report here a new idiopathic granulomatous mastitis case, through a review of literature, trying to present its epidemiologic and clinical aspects, discussing the diagnostical methods and the therapeutic difficulties

[Cancer kidney of adult: pathological study about 139 cases]

The cancer of the kidney accounts for 3% of all adult malignant tumors and have an increased incidence. This retrospective study, reports 139 cases colliged in the Ibn Sina hospital, between 1990 and 1999. It concerns 68 men, 72 women [range 19-88 years]. Most of patients [79.8%] have between 40 and 70 years. The diagnosis was assessed by the histological examination about surgical specimens in 132 cases, renal biopsy in six cases and renal cytopunction in one case. Clear cell carcinoma was more frequent [72%] in 100 cases, metastasis [20.3%] in 28 cases, tubulo-papillary tumors, sarcomatoide carcinoma and wilms tumor [2,1% each other] 3 cases, Bellini carcinoma and clear sarcoma [0,7% each other] one case. Furhman grade as a prognosis factor used in 103 cases that 65% had a high grade [III, IV]. The diagnosis is based by microscopic gross in all of case except in few cases, the immunohistochemistry study was necessary. We insist on the central role of pathologist in prognosis of cancer kidney in adults