ABSTRACT
Objective: The objectives of this study were to assess the different localizations of tuberculosis [TB] in children in a pneumopediatric department in Tunisia and to describe its diagnosis tools since clinical investigations of childhood TB are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens
Methods: Forty-six cases of TB in children were studied between 2008 and 2013. Clinical history, examination and chest radiography were reported. Several investigations have been conducted to confirm the diagnosis of TB such as: tuberculin skin test [TST], bacteriological and histological investigations. Anti-tuberculosis treatment was prescribed according to the national guidelines
Results: Cough and deterioration in general condition were the most frequent symptoms [47.8% and 43.7%]. The other children presented cervical swelling [19.5%], chest pain [17.4%] and hemoptysis [4.3%]. Abnormalities have been found in chest radiography in 35 cases [76%]. TST was positive in 73% of cases. Diagnosis of TB was confirmed in 56.6% of cases by Mycobacterium tuberculosis [MT] isolation and/or biopsy. The diagnosis was made on presumptive arguments in 20 cases [43.4%] based on a history of TB contact, suggestive symptoms and a positive TST. A surgical biopsy was necessary for diagnosis in 17 cases [nasopharynx, bone, cervical, mediastinal and mesenteric lymph nodes]. Pulmonary TB was diagnosed in 52% of cases. Two children were diagnosed with disseminated TB. A diagnosis delay was noted with an average of 20 days and a contact history was found in 52% of the children. All children were treated according to the national guidelines without major side effects. Healing without sequelae was achieved in 91% of cases
Conclusion: Children represent a population at high risk for TB especially after a household contact with a higher frequency of multifocal forms compared to adults. The difficulty of the diagnosis in children may explain partially the diagnosis delay, but efforts must be done to improve prevention and diagnosis in our country
ABSTRACT
Aims: Hepatoid carcinoma is a rare tumor that mimics the morphologic and immunohistochemical features of hepatocellular carcinoma. An exceptional occurrence in adrenal gland has been recorded in the literature. The aim of this work is to study the morphologic immunohistochemical differential diagnosis and prognosis of adrenal hepatoid carcinoma. Presentation of Case: We present a rare case of hepatoid carcinoma of left adrenal gland in 70- year-old-men. Histologically, the adrenal mass was composed of cells with enlarged nuclei, proeminent nucleoli and eosinophilic cytoplasm, arranged in a pseudoglandular and thick trabecular pattern with bile plugs, which resembled hepatocellular carcinoma. The main differential diagnosis was adrenal metastasis from hepatocellular carcinoma. The adrenal gland origin of the hepatoid carcinoma was verified by the absence of liver mass on clinical and imagery grounds. Conclusion: We present the first case of adrenal hepatoid carcinoma in Tunisia. The main differential diagnosis was adrenal metastasis from hepatocellular carcinoma, which was eliminated by the absence of liver tumor.
ABSTRACT
Pulmonary sequestrations are defined by the presence of a non functional pulmonary parenchyma with an abnormal vascularisation. Their incidence ranges from 1.1% to 1.8% of all the malformations in the general population. Two types of sequestrations are described: - Intralobar sequestrations: the most common, localised within a normal parenchyma. - Extralobar sequestrations: totally separate from the lung with their own pleural covering. We report two cases of sequestrations. In the first case, the radioclinical presentation was strongly suggestive of this diagnosis in a 32 - year old woman with recurrent hemoptysis, airspace opacity in the left retrocardiac region and a systemic vascularisation of this mass on tomodensitometry. Pathological studies after surgery confirmed the diagnosis of intralobar sequestration type I in the classification of PRYCE. In the second case a thoracoscopy performed on a 14 - year-old boy who had a serohematic pleural effusion, revealed a left costodiaphragmatic mass. Surgical removal of this mass confirmed its extralobar pulmonary nature