Giant gastric lipoma mimicking well-differentiated liposarcoma

Gastric lipoma is a rare tumor, accounting for only 5% of gastrointestinal tract lipomas and less than 1% of all gastric tumors. Histological diagnosis is usually easy. However, the tumor may sometimes undergo significant inflammatory changes leading to a difficult differential diagnosis with well-differentiated liposarcoma. Authors report the case of a 51-year-old man, presenting with epigastralgia of recent onset. Physical exam was unremarkable. Endoscopy revealed a large, ulcerated, submucosal, and antral tumor. CT scan showed an antral mass with fat attenuation. The patient underwent a total gastrectomy. Macroscopic examination identified in the antral wall a 9-cm, well-circumscribed, nodular lesion, with a greasy cut surface. On histological examination, the tumor was composed of a mature adipocytes proliferation, showing significant variation in cell size, associated to some lipoblasts. Nuclei were sometimes large, irregular, neither with hyperchromasia nor mitosis. Diagnosis of a well-differentiated liposarcoma was suspected and hybridization. The diagnosis of lipoma was made. Twelve months after surgery, the patient is doing well. In conclusion, differentiating benign from malignant fatty tumors is sometimes difficult in morphologic features. In these cases, cytogenetic procedures are the only means for an accurate diagnosis

[Gastric heterotopia: clinical and histological study of 12 cases]

Gastric heterotopia is a rare congenital lesion, described everywhere in the body, but involves predominantly the digestive tract. Diagnosis is based on histologic examination and requires the presence of gastric mucosa, especially fundic. This diagnosis is usually easy, but sometimes it can be misinterpreted as gastric metapalsia. This latter is an aquired and frequent lesion of the gastrointestinal tract. To determine the relationship between this affection and the other digestive malformations, to describe the clinical characteristics and the evolution of this lesion and to discuss the differential diagnosis particularly the gastric metaplasia. Twelve cases of gastric heterotopia were diagnosed over a 12-year period at Habib Thameur Hospital. Clinical data was obtained and all the slides were reviewed. Nine cases were found in Meckel's diverticulum [75%], one case in intestinal duplication, one case in the esophagus and another in the gallbladder. The mean age of patients at diagnosis was 16 years with a peak of incidence at the first decade of life. Intestinal obstruction and digestive bleeding were the most presenting features. Heterotopic gastric mucosa complicates other congenital anomalies such as common mesentery, vestigial polyp of the liver, appendiceal agenesis and heterotopic pancreas. Differential diagnosis consists in gastric metaplasia was found extensively in a patient with Crohn's disease associated with Meckel's diverticulum. Gastric heterotopia is frequently associated with congenital anomalies especially with Meckel's diverticulum and digestive duplication. Diagnosis relies on histology, mainly on finding heterotopic fundic glands in normal organizational structure. Sometimes, differentiating between gastric heterotopia and gastric metaplasia requires clinical confrontation

[Tumors of salivary glands: anatomical study and clinical epidemiology of a series of 180 cases]

The salivary gland tumors are rare [less than 3% of all tumors] and poorly known. In fact, they are numerous and histologically difficult to diagnose. This work aims to point at the different histological types of salivary gland tumors, to draw out the principal epidemiological, clinical, radiological and histological characteristics, and to compare our cases to those of the literature. Accordingly, we performed a descriptive type study about 180 cases of salivary gland tumors from the departments of pathology and oto-rhino-laryngology of Habib Thameur hospital during 25 years, extending from April 1979 to December 2004. Benign tumors were predominant [88%], while malignant ones represented 12% of our cases dominated by carcinomas. The sex-ratio was 0.96. Parotid gland location was the most frequent one, and pleomorphic adenoma was the most frequent tumor [62%]. Histological diversity of salivary tumors results in difficulties for differential diagnosis. These problems can be solved by a precise diagnostic approach and sometimes by an immunohistochemistry study

[Primary synovialosarcoma: a case of unusual location]

Report a new case of primary Synovi alosarcoma. We report a case of a 16 year old girl, who presented with a tumefaction on the right clavicle evolving or 3 months. Various explorations carried out, in particular thoracic scanner and imagery by magnetic resonance, showed a multilocular cystic formation of the seat and the clavicle reaching the mediastinum. A pathological examination of the part [piece] highlighted a biphasic synovialosarcoma of grade III. This diagnosis was validated by the immunohistochemistry study and the detection of transcribed specific fusion of the synovialosarcoma, SYT-SSXI. The unusual locations of the primitive SS must be known because the diversity of their microscopic aspects may cause confusion in the diagnosis. The immunohistochemistry, and more recently the cytogenetic studies, helps to solve these problems of differential diagnosis

[Non alcohol steatohepatitis: pathologic study of 9 cases]

Non alcohol steatohepatitis is an acquired chronic hepatopathy frequently of metabolic origin. Histopathologically, it is characterised by a steatosis associated with necrotic inflammatory lesions mimicking alcohol hepatitis. This disease is complicated by cirrhosis in 15 at 30% of cases and by hepatocellular carcinoma in 13% of cases. The aim of our study was to evaluate the clinico-epidemiological features of this disease and the histopathological degree of hepatic failure. 9 cases of non alcohol steatohepatitis are diagnosed in our hospital in 3 years between 2001 to 2004. The clinical features of patients were determined. The aspect and extent of steatosis was noted and the degree of the necrotical activity was evaluated by the Lee score. We observed strong women prevalence with a sex-ratio of 0,125 and a high frequency between 40 and 60 years. Obesity and diabetes are the most common metabolic disorders encountered in our series. In opposition to published cases, a hepatomegaly and signs of portal hypertension are the most frequent clinical lesions noted in our study. Histopathological evaluation of Lee score finds a mild to moderate activity and fibrosis in nearly all our cases. One case of cirrhosis is noted

[Krukenberg tumor: a clinico pathological study of 5 cases]

Krunkenberg tumor is defined as the ovarian metastases of a primary digestive tumor composed of a signet ring cells. Describe the different characteristics of Krukenberg's tumor to improve diagnostic criteria and the therapeutic approche. Five cases of Krukenberg tumor are diagnosed 5 year period between 2002 and 2005. The c1inic-pathological feature are reported. The patient age was ranged from 31 to 58 years. Most ovarian tumors were diagnosed synchronously cases]. It was a gastric carcinoma in 3 cases and a colonic carcinoma in 2 patients. Histological diagnosis wass easy. We found in 2 cases a metastasis of colonic mucinous adenocarcinoma with signet ring-cell, in 2 other cases it 's a gastric adenocarcinoma with exclusively signet ring cell and in the later case it was a gastric moderately differentiated adenocarcinoma with signet ring cell component. Surgical treatment was given in only 3 patients. Prognosis is always unfavourable. The only-hope for improved prognosis is to search for ovarian metastasis in all cases of digestive tumor

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]

Aim: to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei

Methods: 25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006

Results: 9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocele and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma

Conclusion: Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management

Digestive polyposis, a retrospective study of 20 cases

Three main polyposis syndromes are transmitted as an autosomal dominant disorder: familial adenomatous polyposis [FAP], juvenile polyposis syndrome [JPS] and Peutz-Jeghers syndrome. Evaluate this management of digestive polyposis. Our study included 20 patients which were collected in the departements of pathology surgery and garstroenterology of MT Maarmouri's Hospital, Nabeul city. We reported 15 cases of adenomatous polyposis with 2 family groups. We identified a family group of JPS with 3 members and 2 cases of Peutz-Jeghers syndrome. We found 11 cases of colonic adenocarcinoma out of the 15 patients affected by adenomatous polyposes. FAP is a generalized disorder involving the entire colorectum segment with numerous extra-colonic manifestations. The risk to develop colonic cancer is 100%. JPS is characterised by the development of numerous gastrointestinal juvenile polyps and occurs usually before 20 years old, the progression to cancer is rarely observed. Peutz-Jeghers syndrome consists in hamartomatous polyps associated to a characteristic mucosal pigmentation. The patients are usually young adults and have an increased incidence of cancer in extradigestive sites

[Prevalence of the microscopic colitis to the course of the chronic diarrhea: about 150 cases]

The goal of our survey is to value the microscopic colitis frequency at 150 patients, colliged on a period of 6 years [1997-2003], that have a chronic diarrhea with a normal total coloscopy and that benefitted of systematic biopsies. The microscopic colitis has been recovered at 44 patients on 150 either 29,3%. 16 of our patients [37%] are put on Salazopyrine, they answered well to the treatment with a receding of 3 years. The microscopic colitis is a pathology whose frequency seems under valued, it is certainly benign but can give a frequent diarrhea requiring a curative treatment

[Polymorphous low-grade adenocarcinoma of the salivary glands-case report]

A case of polymorphous low-grade adenocarcinoma of minor salivary gland is reported. This tumor was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms [pleomorphic adenomas] or salivary malignant conditions [malignant pleomorphic adenomos, adenoid cystic carcinomas, papillary adenoccircinomas and adenocarcinoma not otherwise stated]. This neoplasm, with few exceptions, originates in minor salivary gland tissues of the palates or buccal mucosa. It is characteristically slow to enlarge. Clinical reports show the neoplasm present for many years before diagnosis. The tumor have a variety of morphological patterns, a cytological uniformity and an infiltration into adjacent structures. The treatment is a wide local excision. Recurrences and lymph node metastases are rare

Condylome geant de buschke-loewenstein de la region perianale avec envahissement inguinal: a propos d'un cas

The giant condyloma acuminatum of the perianal region is a tumor characterised by its large size with the propensity to infiltratte into deeper tissues, contrasting with a microscopically benign pattern. The evolution after malignant transformation of condyloma and lymph node invasion is rare. However it is exceptionaly observed a lymph node invasion of microscopically benign condyloma acuminatum. The authors report a case of microscopically benign giant condyloma acuminatum of the perianal region associated with inguinal invasion, discovered in a 47 year-old man. Treatment consists in extensive surgery of the tumor and inguinal nodes, followed by a radiation therapy