[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

[Hepatic steatosis in chronic hepatitis B: contributing factors and effect on fibrosis]

To determine factors that contribute to the steatosis's formation in chronic hepatitis B, to evaluate its influence on the development of hepatic fibrosis and to research aim eventual relation to virologic factors in a Tunisian cohort of patients. All patients with chronic hepatitis B confirmed by data of liver biopsy were included in this study, which was enrolled from 1990 to 2006. The studied parameters were: age, gender, body mass index, transaminases, cholesterol, triglycerides. glycaemia and DNA rate, status HBe antigen and the degree of activity and histological fibrosis was estimated according to the score of METAVIR. Fifteen patients [34.1%] among the 44 patients includes in this study had hepatic steatosis; that was mild in 10 patients [66.6%], moderate in 3 cases [20%] and severe in 2 patients [13.4]. The antigen HBe was negative in 27 patients [62.22%.] The mean age of the patients having a steatosis was of 32.33 years versus 27.75 years for those who had no it [p=0.185]. The transaminases rate was superior in patients with steatosis than those without, the difference was not significant. Univariate correlation between predictor variables was studied. Significant predictors to steatosis included body mass index [p=0.011] and cholesterol [p=0.037]. HBe Ag status was not associated with steatosis. Neither activity nor fibrosis was correlated with steatosis. In Tunisian patients, factors contributing to the formation of steatosis during the chronic hepatitis B were the body mass index and the rate of cholesterol. The steatosis did not seem to have an influence on the development of the hepatic fibrosis and seems to be independent on the viral effect

[Sneddon wilkinson's subcorneal pustular dermatosis: an atypical case]

Sneddon-Wilkinson disease [SW] is chronic and benign disease belonging to the heterogeneous spectrum of neutrophilic diseases. It is characterised by flask, superficial, aseptic pustules, mainly involving the trunk axilla and inguinal folds, favourably responsive to sulfones. We report an original case with an atypical clinical presentation and course. A 25-year old women presented with an erythematous pustular eruption appeared one week ago. Similar flares were reported since 3 years. No drug intake history nor recent infection were reported. Physical examination showed superficial pustules mainly located on the face and limbs, lying on an erythematous skin and sometimes grouped in larges plaques with a serpiginous disposition having a characteristic aspect of hypopion pustule. A specimen taken from the pustules did not show bacterial or fungal infection. Histological examination of a biopsy specimen showed subcorneal pustules with a dermal peri-capillar neutrophilic infiltrate. Direct immunofluoresence was negative. No associated diseases were found. The patient was resistant to a 1 month treatment with dapsone [100mg/day]. Improvement was obtained with acitretin [25mg/day] within 3 months. Our case has some specificities: cephalic involvement, resistance to dapsone and favourable outcome to a low dose of acitretin

[Naso-sinusienne sarcoidosis]

Background: Sarcoidosis is an ubiquity disease, which can infiltrate all tissues. The cutaneous and ophthalmologic thoracic localizations are most frequent. The nasosinusienne localisation is rare

Aim: The authors report their observations of 4 patients: 2 men and 2 women with a mean age 47,5 years [42-56]. These cases was diagnosed and treated between January 1998 and December 2003 in the ENT service of the Habib Thameur hospital

Cases: The diagnosis was related to a nasal or a sinuses biopsy. The assessment of extention was negative in 3 cases. The corticoid treatment in local pulverization was sufficient in 2 cases. The corticoid treatment by systematic way was obtained in all the cases. The naso sinusienne localization is rare, it is exceptionally isolated. The clinical and radiological symptoms are not specifics. Principal element of the symptoms are not specifics. Principal element of the diagnosis is the directed biopsy, easy in this localization

[Prospective study of 420 biopsies realised in patients with duodenal ulcer with positive Helcobacter pylori]

It's a prospective study leaded between September 1997 and July 1999 [23 months] in 75 patients with duodenal ulcer and positif for Helicobacter pylori. All patients had a first endoscopy with antral, fundic and duodenal biopsies, followed one months later by a second control fibroscopy with biopsies of the same sites. A total of 420 biopsies was realized. Chronic gastritis was evaluated according to sydney system. Patients was divided by randomization in 4 groups. Every group was received a different therapeutic association. The results was conform to liberation concerning activity 80%, intestinal metaplasia 12%, inflammation 100%. Atrophy was observed in 56% of cases, this percentage is variable in literature; chronic gastritis was predominant in antre relatively to fundus [p< 0.005]. After treatment, a significative fall of Helicobacter pylori and activity and atrophy was established, contrariety to intestinal metaplasia and chronic inflammation witch are persisted. The prevalence of follicular gastritis was 57%. The better rate of ulcer cicatrisation and Helicobacter pylori eradication was respectively of 79% and 66% in group 1 treated by omeprazol, amoxicillin, metronidazol by comparison with the others 3 groups [p< 0.005]

Filiation Hamartoma polyposis dysplasia and small bowel adeno-carcinoma

Peutz-Jeghers syndrome is a hereditary affection with dominant autosomal transmission. The risk of cancerisation is largely higher than that in the general population. Dysplasia is rare. Transformation of the polyposis hamartoma into a site of dysplasia then into adenocarcinoma has been rarely reported. The authors report the case of a 14 year-old patient, having a severe dysplasia on ileal polyposis hamartoma related to the syndrome of Peutz-Jeghers

[Gastrointhstinal stromal tumors. a study of 5 cases]

G1 stromal tumors are mesenchymatal tumors arising primarily from the digestive tract or from the omentum. Despite their rarity [less than I% of digestive tumors]. These tumors have become of current interest since the discovery of a treatment for metastatic and locally advanced tumors, the imatinib [Glivecr]. In this study we report 5 cases of stromal tumors. Patients were 42 years old an average. Abdominal mass was the revealing signal in 80% of cases, localisation was obtained by endoscopy and ultrasonography in 60% cases. Total resection of the tumor was performed in all patients. Immuno-histochemical examination confirmed the diagnosis of stromal tumors. Based on these cases and on a review of literature, we insist on the diagnostic difficulties of this rare pathology, while trying to determine the histological prognostic parameters and the latest therapeutic methods

Histiocytome fibreux angiomatoide: Une tumeur rare a malignite intermediaire

Angiomatoid fibrous histiocytoma is a rare humour affecting young adults. Unlike conventional malignant fibrous histiocytoma, it's extension is only local thus giving a good prognosis. We report the cases of a 9 years-old girl and a 1 6 years-old boy presenting respectively, with an axiliary tumour 5cm of diameter and a paravertebral subcutaneous tumour 1,5cm of diameter. In both cases, the diagnosis was not initially suspected. The treatment consisted in surgical resection

Le syndrome de destombes-rosai-dorfman [a propos d'un cas]

The sinus histiocytosis with massive lymphadenopathy or Destombes-Rosai-Dorfman syndrome is a reactional nodal histiocytosis which is mainly found in children and adolescents, characterised by bilateral and voluminous lymphadenopathy with a proconsular neck. We report a tunisian case of 10 years-old male who presented with general health deterioration and developed later voluminous bilateral, cervical lymphadenopathy. A nodal biopsy permitted the diagnosis of massive lymphadenopathy of Destombes-Rosai-Dorfman. The response to corticotherapy was favorable with improvement of general health and regression of the lymphadenopathy