Myelodysplastic syndrome and pancytopenia responding to treatment of hyperthyroidism: peripheral blood and bone marrow analysis before and after antihormonal treatment.

Hematological disorders, especially single lineage abnormalities, have been described in hyperthyroidism. Pancytopenia has been reported, without myelodysplastic syndrome or megaloblastic anemia. We studied the peripheral blood smear and the bone marrow aspiration and biopsy of a 65-year-old lady, who presented with pancytopenia and thyrotoxicosis due to multinodular goiter. She denied ingesting any toxic medication. At diagnosis: WBC: 2500/ul, platelets count: 58,000/ul, hemoglobin level: 6.5 g/dl. The bone marrow was moderately hyper cellular with moderate myelofibrosis and arrested hematopoiesis. The TSH level was: 0.02 mIU/l (N: 0.25-4), the fT3: 18 pmol/l (N: 4-10), the routine serum immunologic tests were negative. After treatment with single agent neomercazole (carbimazole), complete recovery of the blood cell counts was obtained within one month. The bone marrow aspiration, performed three months after starting therapy, showed normal hematopoiesis. The thyroid function tests returned to normal and no autoimmune reaction was detected on routine serum testing. Persistent response was observed six months later under medical treatment. The patient has refused surgical treatment. Reversible myelodysplastic syndrome may also be part of the changes in blood picture of patients with hyperthyroidism, probably due to direct toxic mechanism.

histiocytose a cellules de Langerhans pulmonaire de l' adulte

Pulmonary Langerhans cell histiocytosis belongs to the spectrum of the Langerhans' cell histiocytosis. The common point is tissue infiltration by Langerhans' cell granuloma. But the pulmonary type occurs predominantly in young adults and is associated with tobacco. The most frequently encountered symptoms are cough and dyspnea. Twenty-five to 35% of the cases are incidental findings. 20% of cases present with extra-thoracic lesions including skin, bone and hypothalamo-pituitary axis. On scanning images the lung parenchyma is infiltrated at the beginning by stellar nodules of less than 10 mm, which evolve either gradually to form cysts or towards remission, spontaneous or induced by the treatment. With pulmonary function testing, the two types of anomalies [obstruction and restriction] are observed. The reduction in diffusing capacity observed in 60 to 90% of the cases reflects the pulmonary vascular involvement. Detec-tion of more than 5% of CD-la cells in bronchiolo-alveolar lavage fluid and transbronchial biopsies are not sensitive. Treatment is controversial and includes primarily smoking cessation and corticosteroid therapy at the early nodular stage

Carcinome metaplasique de sein. A propos d'un cas de type sarcomatoide et revue de la literature

Metaplastic changes are a rare entity that occurs in fewer than 5% of breast carcinomas. Their sarcomatoid variant is the rarest primary malignancy of the breast. We report a case of sarcomatoid breast cancer and insist on the diagnosis and treatment of this rare tumor. case report: A 71-year-old female patient presented for a right breast mass above the nipple, between the upper inner and upper outer quadrants, of 20 mm of diameter, highly dense on mammography with cystic and solid components on ultrasound core biopsy showed a probable sarcoma whereas the partial mastectomy revealed the sarcomatoid metaplastic breast carcinoma. The workout for distant metastasis was negative and the treatment was completed by a modified radical mastectomy and adjuvant CMF chemotherapy. Six months after treatment there was no evidence of locoregional recurrence nor distant metastases. Although metaplastic carcinoma is a rare breast malignancy, with no specific clinical or radiologic features, it should be considered as an independent entity and included in the differential diagnosis of breast tumors

Interest of endoscopic biopsy in the management of gastritis: about 250 consecutive cases

Background The practical role of gastric biopsy in the management of gastritis is controversial. Aim To estimate the yield of endoscopic biopsies in the clinical, endoscopic and pathologic approach of gastritis. Material and methods: Prospective study of 250 consecutive patients who underwent an upper G.I. endoscopy between July 1996 and January 1997, for upper G I symptoms, miscellaneous manifestations requiring an upper G.I. endoscopy or presenting a gastritis on EGD performed for other indications. Every patient had 6 biopsies: 2 in the antrum, 2 in the corpus, and 2 in an intermediate zone. Results After defining the abnormal elemental endoscopic and pathologic patterns, gastric mucosa was endoscopically normal in 57 cases [22.8%] and abnormal in the remaining of the 250 cases [77.2%]. The pathologic findings were normal in 69 cases [27.6%] and abnormal in the remaining 181 cases of 250. H pylori was found in 126 cases [50.4%], 10 cases of which [7.9%] had normal pathology. There was no significant correlation between clinical symptoms, endoscopy and pathology. There was a correlation between endoscopic abnormalities and tobacco use [P = 0.0073], NSAIDs use [P 0,0001] and the presence of H. pylori [P < 0,0001]. There was also a correlation between pathologic findings, tobacco use [P = 0.0015], NSAIDs use [P = 0.0022] and the presence of HP [P < 0.0001] On the other hand, there was a correlation between the presence of an inflammatory infiltrate in H. pylori gastritis [P 0.0007] and its absence in NSAIDs use [P = 0.0003]. The correlation between endoscopy and pathology existed only for certains patterns: erosion and ulcerations [P = 0.0002], purpuric [P = 0.033], congestion [P < 0.0001] and mosaic [0.0095]. Conclusion: Gastric biopsy brings no important practical supplement to endoscopic examination except in revealing the presence of H. pylori. It adds nothing to endoscopy in helping explain the clinical symptoms. But it is obvious that it may reveal some serious pre-malignant dysplasia or malignant gastric lesions [maltoma, linitis plastica]. This did not occur during our study

Mesotheliome - asbeste au Liban: un probleme a retenir

To estimate the incidence of pleural mesothelioma and its relationship with the occupational and environmental exposure to asbestos in Chekka region. Between 1991 and 2000, 22 cases of malignant mesothelioma were diagnosed at Hotel-Dieu de France Hospital. Eighteen cases were epidemiologically investigated. Fifteen among these 18 patients [83%] had a positive exposure history exposure was occupational in 11 cases and environmental in 4 cases.The tumor was attributable to Eternit Company in 12 cases among the exposed 15 [80%]. These 12 cases were secondary to occupational exposures in 8 and to environmental exposure in 4 cases. Mean latency period between exposition and diagnosis was 29 years. Fifteen patients died from the progression of their disease after a median survival of 8 months. The relationship between pleural mesothelioma and Eternit Company with the related occupational and environmental risk in Chekka region is obvious.The assessment of the incidence needs a national cancer registry.Despite the protective measures taken by the government since-1996, an increase in the incidence is suspected in the coming ten years because of the long latency period of the disease

Actinomycose vertebrale. A propos d'un cas et revue de la litterature

In this article, the case of a 32-year-old man with a paravertebral actinomycosis is discussed. Initially, the diagnosis was not obvious but it was confirmed later with the repetitive radiologic procedures, the elimination of other etiologies [purulent, mycobacterial or mycotic infections and neoplasia] and the biopsy Treatment with penicillin initially and then with tetracycline for a long term led to a very good outcome at a 3-year follow-up with a radiologic remission. Following the discussion of the case, a review of the literature concerning the paravertebral actinomycosis, its diagnostic clues and treatment is undertaken

Carcinomes mammaires: evaluation des recepteurs hormonaux et des marqueurs p52, erb-B2, P-glycoprotein, et Ki-67

The present study was performed on 45 mammary biopsies submitted to the Pathology Department, Hotel-Dieu de France Hospital, for evaluation of hormonal receptor. Histological typing and grading did not reveal any difference with the literature, but the mean size of tumor at clinical presentation was 4 cm [ +/- 1.6] and 83% of patients with known lymph node status, had metastases. Immunohistochemical assay for hormonal receptors on frozen sections disclosed positivity for estrogen and progesterone receptors in 18 cases [43%], similar to other studies. pS2, intracytoplasmic estrogen-induced protein, is positive in 19 out of 32 studied cases [59%], similar to what is reported by others. The latter does not appear to bring more information than hormone receptors considering therapy and prognosis. Oncoprotein C-erb B2 membrane over-expression is noted in 65% with no significant correlation to histological grade/size of tumor or node status. Antigen Ki-67 marker demonstrates high proliferation rates in 19 tumors [48.7%]. The markers studied do not seem to be more conclusive than the hormone receptors. The major fact disclosed by the study of this small series is the advanced stage at clinical presentation, urging an adequate medical education of the Lebanese population, and prompting to appropriate self-screening. Nevertheless, new tumor markers are continuously presented in the literature. In this era of marker extravaganza, a "wait-and-see" attitude would be a wise alternative

Tumeur d'abrikossof de l'oesophage: a propos d'un cas

Systematic eso-gastric endoscopy allowed the discovery of a granular cell tumor. Also known as Abrikossof's tumor, the latter is a benign lesion, usually symptomless, unless it is large in size, or associated with a malignant tumor. Grossly it is a polypoid, submucosal tumor. Diagnosis is microscopic, confirmed by immunohistochemistry, unless biopsies are superficial, and show only the usually associated pseudo-carcinomatous hyperplasia. Therapeutic approach depends on the symptoms, mainly dysphagia, which is related to the size of the tumor