[Primary breast lymphoma: a case report]

Non-hodgkinian's lymphoma [NHL] represents 0.04 to 0.53% of all breast cancers. The clinical aspects and therapeutic models of the disease are a subject of debate. The purpose of this paper is to report the clinical, imaging [sonographic, mammographic and MRI] and pathological features of breast lymphoma, a rare but aggressive tumor, based on a case report review. We report a case of primary non-hodgkinian's lymphoma of the breast in one patient aged of 52 years. The patient weart to a systematic screening of breast cancer. Physical examen was normal. Mammography showed breast with transitional density, BIRADS type 2, micro-calcifications behin the .... but sometimes it had linear ...., neither not distorsion were identified. Ultrasonography did not show a tumor. The disease was revealed by breast MRI. The additional value of MRI in diagnosis is validated in our patient. In fact,when cancer is occult, size evaluation is difficult at standard imaging [7mm]. The diagnosis of non-hodgkinian's lymphoma was confirmed on histological examination of tumor biopsies. It was a B-cell non-Hodgkins-type lymphoma. The clinical features have been reviewed and the tumor have been evaluated both on a morphologic and an immunohistochemical basis. With chemotherapy, the course was favourable. The breast is an uncommon site of development of malignant lymphomas. Secondary disease is more common than the primitive form. Primary breast lymphoma is a difficult diagnosis because it is very rare. The diagnosis is mainly histological. Chemotherapy is the principal therapeutic mean. Treatment combines radiotherapy and chemotherapy. Prognosis is generally bad

[ rare pelvic hydatid cyst]

Pelvic localization of hydatid cyst is uncommon even in endemic countries such as Tunisia. Localization in the broad ligament represents only 0.3% of cases. A 22 year's old woman had consulted for a pelvic pain operating for a month. An abdominal ultrasound had found a compartmentalized cystic formation of 145mm lateralized to the left. The surgical exploration had found a hydatid cyst of the left broad ligament, which was resected. Hydatid cyst of the broad ligament remains extremely rare, treatment is surgical and is the only guarantee of a disease free survival

[Breast cancer in Tunisia: epidemiologic characteristics and trends in incidence]

The goal of this study is to analyze certain epidemiologic characteristics of breast cancer in Tunisia and to foresee the consequences that will arise from the trends in incidence of this cancer. Data obtained from the North-Tunisia Cancer Registry [NTCR] and from the Salah AZAIZ Institute [SAI] Registry is used to estimate the different incidence rates and to compare these rates with those of other countries. In 15 years the crude incidence rate for breast cancer in the North Tunisia almost doubled to reach 21.5 cases / 100, 000 women per year during 1994-1998. The high rate of this cancer among women younger than 35 years [11%] could be related to a relatively low incidence among post-menopausal women. The clinical profile of breast cancer remains quite alarming: 40.2% of cases have a tumor with a clinical diameter equal or greater than 5 cm. Birth cohort effect, also know as the generation effect, is expected to lead to an increase of cancer incidence in the future. The rather high number of young cases is a source of additional cost on social and financial level. The priority is now to solve the problem of late diagnosis it has aggravated the prognosis of this cancer in Tunisia

[Practice of large scale mammography Ariana in state in Tunisia: precluding for an organized screening?]

To study and analyse the results of breast cancer mammography screening program in the Ariana state and to try to determinate its feasibility and reproducibility on a broader scale. A pilot study on the mammography feasibility of screening with large scales was initiated, by Family and Population National Office, in September 2003. The duration of the study was fixed at 5 years. The adopted protocol takes account of epidemiologic and socialcultural specificities of Tunisian environment that is in the selection and in the mode of recruitment of the target population as well as in the choice of the adopted radiological protocol. 8244 women were screened in the first round. The majority of sensitized women was recruited in residence and in the reproductive and health centers. Nevertheless, recruitment in residence was proved to be heavy, not very effective and no reproducible in a broader scale. The participation rate was weak [9.6%]. The channels of sensitizing used made it possible to touch in manner more important the "young" women [Middle Age 48.6 years]. The absence of radiologist on the spot involved the recall of 18.1% of the women for which a complementary assessment was necessary, has to contribute to increase the stress among certain women and to increase the average time of reading which was, in this case, 61.7 days. The majority of the women profited from the double reading of the tests [99.4%]. On the whole 50 women presented a cancer including 40 detected by the program and 10 interval cancers. This study has permitted to study the feasibility of mammography study. Except the topic of the cost, the two hand conditions of his feasibility binds in the systematic invitation of the women as well as in the wider uses of sensitization and information ways of the population

[Results and evaluation of 3 years of large scale mammography program in the Ariana state in Tunisia]

To asses and analyse the results of 3 years large scale mammography screening of breast cancer in Ariana state in Tunisia This program, managed by the Family and Population National Office, was addressing to women aged from 49 to 69 years old residing in a area with adds up a population of 459 700 inhabitants including 52 729 women in the target age population. The screening was including a breast clinical examination and a mammography with two incidences face and external profile. The women was invited at their residence or were sensitized in the reproductive health centers, care and base health centers or by a close relation which heard of the program. An enlightened assent was submitted to the women who wished to profit from the screening. In three years, 9093 mammography were carried out of which 8244 were retained in the analyses, that is to say a rate participation of 9, 6%. The rate of women recalled for suspect test was of 18, 1% and it was of 13, 1% among women of more than 50 years. The rate of practiced surgical biopsies was of 0, 5% and the positive predictive value was of 45, 5%. The average time between the date of screening and the result of the screening was 9, 7 days, more important in the event of tests requiring a complementary assessment [61, 7 days]. On the whole 40 cancers were detected by the program, that is to say a rough rate of detected cancers, of 4, 9%, in conformity with the recommendations. The percentage of invasive cancers

[Preliminary results and analysis of feasability of mammographic breast cancer screening in women younger than 50 years of the L'Ariana state of Tunisia]

To report the preliminary results of the feasibility of breast cancer mammographic screening among women younger than 50 years from the l'Ariana state of Tunisia. The National office of the Family and Population [ONFP] launched a protocol on feasibility of breast cancer mammographic screening targeting asymptomatic women aged 40-69 years, from the l'Ariana state in Tunisia. We practiced two oblique and face incidences at the mammography screening unit of the ONFP, whose equipment and control system of quality answered to the European Communitiy for breast cancer screening. We did 5325 mammograms between April 2004 and March 2006. Our targeted population had a 48, 9 years mean age [CI 95% = [48.7 - 49.1]], 60, 3% of them younger than 50 years. There were more young women with high breast denisty [8.2%] compared to the group from 50 to 69 years [2,1%]. The women arising from the 40-49 years cohort had a socio-economic and educational level higher. The complementary rate of examination/explorations was higher in this cohort [19.5%] vs 11.5% for the 50-69 years. The youngest women presented a more often positive test [7.0 vs 5.2%] than the oldest women [p<0.01]. The option to screen breast cancer by mammography in women younger than 40 years in Tunisia is partially justified by the relatively high frequency of this cancer in this age group. Our feasibility poorly useful in screening will be used to sensibilise females to the problematic of breast cancer to obtain a better compliance compared to the older age group of 50-59 years

[Radio-histological correlation of the microcalcifications of the breast: Tunisian center experience]

Evaluation of surgical biopsy for mammary microcalcifications, in Tunisian patients according to the American College of Radiology's recommandations [ACR]. 100 patients treated in Salah Azaiez Institute from January 2005 to December 2006, who underwent surgical biopsy for breast microcalcifications. The diagnosis was based on mammography associated in 60% of the cases, to ultra-sonography. We correlated biopsies results to ACR classification. 123 surgical biopsies are related to ACR 3 lesions in 72 cases [58, 5%] ACR 4 in 39 cases [32%] and ACR 5 in 4 case [11, 5%]. The histological examination showed malignant lesions in 4 cas/72 ACR3 [5, 5%], 19/39 ACR4 [48, 7%] and 10 among the ACR5 [71, 4%]. Our preliminary study introduces a diagnostic approach of mammary microcalcifications that are usually infra-clinic lesions, in a general context of breast tumors detected with an average size of more than 3cm

[Surgical treatment of infraclinical breast lesions: preliminary results of the screening program of L'Ariana state]

To report clinical, radiological and histological characteristics of the infraclinical breast lesions patients recruited via the large scale mammography breast cancer screening of l'Ariana state in Tunisia. Retrospective study over a period of 2 years. The recruitment of patients made on the occasion of the program of breast cancer screening. During this period, 22 patients in our unity had a surgical excision after wire localization. Ten patients were recruited by means of systematic breast cancer screening. In these cases, the mammographic findings were classified B.I.R.A.D.S 4 in 7 cases and BIRADS type 5 in 3 cases. Definitive histology concluded to benign disease in 4 cases and malignancy 6 cases. This collaboration enables the diagnosis an invasive ductal carcinoma in three cases. The surgical excision after wire localization for non palpable breast lesions allows diagnosis of high-risk benign lesions and low-stage breast cancer. It is a reliable technique which indications have to be based on clinical and radiological strict criteria. This procedure is at present, and in developed countries, widely outstripped with the stereotactic core needle biopsy

[Satisfaction inquiry within women involved in the pilot program of large scale mammography in the Ariana state in Tunisia]

Evaluate the degree of satisfaction of women included in the large scale mammography program of breast cancer screening in the state of Ariana in Tunisia. Within the women explored by mammography, we have contaced 112 patients who had a positive screening requiring histological checking. We have established a questionnaire concerning: the invitation, the clinical examination, the result announcement and the therapeutic management. The average age of patients was 49 years. 64% had a primary education level. 80 women or 71.4% were satisfied with the process of screening and the method of announcement. The main cause of dissatisfaction for patients with cancer diagnosis was delay and difficult access to adjuvant treatments. Among patients who had histological diagnosis: 47.3% had a malignant disease [53 cases] against 37.5% of benign [42 cases]. 100% of patients who had a pathological result reassuring are satisfied at the end of the screening program. The psychosocial impact of screening must be considered for the development of new programs. The waiting and announcement of results are essential factors that allow us to judge the success of the project, because of patient satisfaction will depend the quality of monitoring and adherence to screening

[Estimation of years of life gained within the pilot screening program of L'Ariana stale in Tunisia]

Breast cancer is the principle cancer among female cancer in Tunisia. It represents 30% of the woman's cancers with about 1000 new cases per year. The main intervention control is mass screening living mammography in to reduce breast cancer mortality. Breast cancer screening efficacy in term of breast cancer mortality reduction is closely related to incidence and survival of this cancer. National Office of Family and Population [ONFP] conducted a pilot experience of breast cancer mass screening using the mammography in place. The main objective of this study is to calculate the potential number of life years saved through this pilot experience of the ONFP. For the methodology, we used the software Dismod [Disease Model] or the evaluation of the prevalence and the duration of the cancer of the breast in the governorate, as well as to estimate the number of life years saved. The potential breast cancer mortality reduction is 30% for women aged of 50 at 69 years. and 10% for those aged of 40 at 49 years. Breast cancer incidence in Ariana according to age for the period 1995-1998, has been calculated from the data have of cancer registry of the North of Tunisia. According to Dismod. mean duration in the absence of screening, is 11.12 years for the age group 40 to 49 years and 9.57 or the age group 50 at 69 years. Screening would increase these duration means of 2.22 years and 1.71 years. respectively for age groups 40 to 49 years and 50 at 69 years. The number of life years saved for 1000 women is of 2.97 years. In conclusion breast cancer screening using mammography would be actually little benefit in Tunisia. Mammography should he reserved for the diagnosis of the suspected cases and screening for high risk women

[Non functional paraganglioma of the organ of Zuckerkandl a case report]

We report a case of non secreting retroperitoneal paraganglioma which developed on the organ of Zuckerkandl in a 28-years-old woman. Paraganglioma is a rare tumor of the paraganglionar system arising from undifferentiated cells of the neural crest. The originality of our observation comes from the non-secreting character of the tumor and rarity of this location

[Malakoplakia of the bladder: a cases report and review of the literature about a cases report]

Malakoplakia is an uncommon granulomatous response to chronic urinary tract infections which may mimic malignancy radiologically and/or endoscopically. The diagnosis is made on histological examination. The treatment is based on antibiotherapy associated with histological drugs. The surgical treatment is indicated when the organ is severely damaged. We report a ease of malakoplakia of the bladder in a 45 years old man

[Mixed mullerian tumors of uterus - about 25 cases]

The malignant mixed mullerian tumours [MMMT] or carcinosarcoma of the uterus are rare tumours, they represent 1,4% of all uterine neoplasia. They are characterized historically by double components carcinomatous and sarcomatous. We performed a retrospective study about 25 cases of carcinosarcoma of the endometrium, collected in Salah Azaiz Institute over a period of 30 years going from 1970 to 2000. The mean patient age was 60 years, and 68% of patients were menopaused. The metrorrhagia was revealing in 66% of cases. Clinically, an abdominopelvic mass was found in 12% of the cases. The pathological diagnosis was done in 12 endometrial biopsies and 10 biopsies of the tumour exteriorisated by the cervix. Surgery is the mainstay of the treatment. The prognosis remains dismal

[Transformation of dermatofibrosarcoma protuberans on a fibrosarcoma-A case report]

The dermatofibrosarcoma protuberans is a rare cutaneous mesenchymal tumor characterized by a low potential of malignancy with a very low rate of metastasis but an important rate of local recurrence. Its transformation on a fibrosarcoma is exceptional, responsible of a higher metastatic potential. This transformation leads to a better surveillance. With a case report and literature review we will try to remember epidemiological, physical, histological, therapeutic, and outcome particularities of this entity

Basal cell carcinoma of the vulva. Case report and review of the literature

Basal cell carcinoma [BCC] accounts for 2 to 3% of all vulvar malignancies and for less than 1% of all BCC. More than 250 cases of vulvar BCC have been reported in the literature. Clinical, pathological and follow up data are similar to results in the present series. Treatment of choice consists of surgical excision with tumor-free margins. Because of local recurrence risk and possible association with other primary cancers in this age group, long term follow-up is necessary. We report a case of BCC of the vulva occurring in a 60 years old woman

[Embryonal rhabdomyosarcoma of the uterine cervix - a case report

Rhabdomyosarcoma of the uterine cervix is an uncommon highly malignant tumour. It usually presents in the adolescent age group. Only 4 cases of rhabdomyosarcoma of the uterine cervix had been reported in women in perimenopausal. Treatment had evolved since new chemotherapy protocols and better classification has been established by the Intergroup Rhabdomyosarcoma Study. One case of Embryonal rhabdomyosarcoma of the uterine cervix is reported in a 47 years woman. She was treated with surgery and external radiotherapy. After 12 months, no signs of recurrence are reported