[Kikuchi-Fujimoto's disease]

The necrotizing histiocyte lymphadenitis is a disease of unknown cause. Clinicians should be aware of this uncommon disease in order to differentiate it from lymphoma, infectious adenitis, and collagenosis. A 24-year-old woman consulted for a right cervical mass which had developed rapidly with no associated symptom. Laboratory results were normal. The gangular biopsy confirmed the diagnosis of necrotizing hymphanditis. Necrotizing histiocyte lymphadenitis is generally observed in young women in their twenties. There has been no predominant ethnic backgrouns. Clinically, it is characterized by lymphadenitis of one or more lymph nodes, predominantly in the cervical region. The Laboratory tests are normal excepting for discrete signs of inflammation. Diagnosis anatomopathologic, the characteristic features include focal necrosis predominantly in the paracortical region with abundant karyorrhectic debris and atypical mononuclear cells around the necrotic zone [crescent-shaped histiocytes, plasmacytoid monocytes, and small lymphocytes and immunoblasts]. The clinical course is generally spontaneously favorable in six months. Relapse is uncommon. The clinicopathologic picture can be confused with a malignant blood disease particularly lymphoma. Evolution is benign and healing without treatment is the rule

[Chronic lymphocytic leukemia: flow cytometry contribution]

Chronic lymphocytic leukemia is a part of B lympho-proliferative diseases. Clinically, it is an indolent disease thought it has a variable evolution. Our aim is to focus on the importance of flow cytometry in the diagnosis of chronic lymphocytic leukemia. This is a prospective survey conducted in 2005/2006, concerned 13 cases of chronic lymphocytic leukaemia from 42 B-cell chronic lymphoproliferative syndromes. The clinical features were summarized in the data file filled by the practicians. Chronic lymphocytic leukemia is studied in our laboratory by different means such as: hemogramm with a morphological aspects of peripheral lymphocytes, osteomedulhary biopsy myelogram, and immunophenotyping by FC500 [Trade Mark] cytometer[Beckman Coulter]. Within the 13 cases of chronic lymphocytic leukemia, there were 9 male and 4 female having a mean age of 68.5 years old with extremes from 45 to 80 years old. The most important signs found were: polyadenopathy, splenomegaly or cytopenia. In our patients, lmphocytosis was ranged from 5,6 a 136 g/l. The marrow was infiltrated by small lymphocytes in some cases. The cytometric analysis was based on Matutes score. In most cases, the chronic lymphocytic leukemia diagnosis seems to be easy based on the hemogram and immunophenotyping. Actually, treatment of patient with chronic lymphocytic leukemia depends on Rai or Binet classifications; still, it is important to have more a other accurate markers dae to its variable evolution. Flow cytometry is of real help in the diagnosis and the monitoring of residual disease in chronic lymphocyte leukemia

[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

[Primary gastric lymphoma: a retrospective series of 35 cases]

Primary gastric non Hodgkin's lymphoma [PGNHL] is the most common site of extranodal malignant lymphoma. It is a rare subtype of malignancy, for which no consensus exists about treatment. The purpose of This paper was to assess the management of PGNHL. Between January 1992 and December 2001,35 patients were retrospectively evaluated. Of the 35 patients, with a mean age of 44 years old Signs, and symptoms are unspecific. 20[57,1%] were in stage IE/IIEI. 15 patients [42,8%] were in stage 11E2,IIIE,IVE. These patients were treated with primary surgery with or without chemotherapy [11;31,4%]; primary chemotherapy [CT] alone with surgery in one patient [21: 60%] and three patients with gastric MALT lymphoma were treated by Helicobacter pylori eradication. The 5 year survival rates of the 35 patients are 62, 86%. There was no significant difference in the 5 year survival rate between the patients with low grade lymphoma and the patients with large grade Iymphoma [75% versus 60%, P=0,467]. The 5-year survival rates for stage I/IIEl and IIE2/lIl/lV patients were 80%, 53,3% respectively [p < 0.144]. Of the 11 primary surgical groups with or without chemotherapy, the 5 year survival rate is 90, 9%. Of the 21 patients who received CT, alone or combined with surgery, the survival rate is 52,4%. There was significant difference between the two groups [P=0,05]. Of the 3 patients with low-grade mucosa-associated lymphoid tissue [MALT] lymphoma with only oral anti-Helicobacter pylori regimen remained disease free after a median follow-up of two years. This study suggested that primary surgical resection may be important factor predicting the long-term survival of patients with primary gastric NHL. H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma

Leiomyome renal

Renal leiomyoma is a benign tumour arising from the smooth muscle cells of different kidney structures. We demonstrate here by this observation, the preoperative diagnostic difficulties and the necesity to consider this entity when confronted with a renal mass case, through reporting a case of a female patient aged 54 years, who consulted for a left loin pain since two years. Clinical examination was normal. Ultrasound examination showed a hyperechogenic nodular formation of 30 mm diameter. The abdomenopelvic C.T scan revealed a superior pole tissue mass of 32 / 28 mm radiological data, a total nephrectomy was done. The anatomopathological examination of surgeical sepcimen showed a subcapsular nodular tumour, confirmation of renal leiomyoma was done by a histological examination. Diagnosis of renal leiomyoma is extremely difficult due to the variability of its radiological findings, so we should put in consideration this benign tumour when dealing with, the differential diagnosis of renal tumours

Graves disease secondary to interferon therapy for chronic hepatitis C

The interferon are naturally induced proteins by the immune system. They have biologic and clinical demonstrations of auto-immunity. Among these demonstrations thyroid anti-body apparition and emergence of dysthyroidism notably the Graves disease. We present a case of a woman followed up for a chronic hepatitis C. Her treatment was interferon and ribavirine and she developed hyperthyroidism. The stop of the antiviral treatment and the administration of anti thyroid were sufficient to treat this affection. It can be encouraged by factors notably age, sex and presence of TPO antibody. The C virus can induce dysthyroidism. The clinical and biological symptoms were similar to the spontaneous Graves disease. The follow up of interferon therapy for chronic hepatitis C was very important