Evaluation of microsatellite instability, MLH1 espression and hMLH1 promoter hypermethylation in colorectal carcinomas among Tunisians patients

About 10% to 15% of sporadic colorectal cancers demonstrate high level of microsatellite instability that is generally associated with aberrant methylation of hMLH1 promoter. To investigate the association between MSI status, hMLH1 protein expression and methylation status of the hMLH1 promoter in a cohort of Tunisian sporadic colorectal cancer. Expression of MLH1 and MSH2 was determined by immunohistochemestry and the MSI status was analysed by microfluid-based on-chip electrophoresis. Methylation of the hMLH1 gene promoter was determined by methylation-specific PCR. Of the 140 colorectal cancers 57% were MSS, 28% were MSI-L and 15% were MSI-H. MSI-H tumors were more frequently right-sided, exhibited a stage III of TNM and tended more to be mucinous. The MSI status had no effect on overall patient survival. Most of the MSS/MSI-L 79% cancers were unmethylated at the hMLH1 promoter, while 26% MSI-H cancers were unmethylated. 84% of MSS and MSI-L expressed MLH1 and 52% of MSI-H expressed MLH1. Of the methylated MSI-H cases, 35% expressed MLH1 protein while 100% of the unmethylated MSI-H were positive for MLH1 staining. Of 11 MSI-H cancers with loss of MLH1 expression, all cases were also methylated while 50% MSI-H cancers with positive immunostaining for MLH1 were methylated at the hMLH1 promoter. Our study showed that MSI-H phenotype was mucinous, right-side and exhibit stade III of TNM. The relative correlation of MLH1 expression and promoter hypermethylation of hMLH1 for the MSI status is similar to that reported for several study

[Lipoma of the uterus: clinical and ethiopathological approach of 7 cases with immunohistochemical study of histogenesis]

Lipoleiomyoma of the uterus [LLU] is an extremely rare, benign, uterine tumour. This rare disease was unknown for a long time. Their histogenesis remains controversial. To describe the clinical and pathological aspects of uterine lipoleiomyoma and to try to specify, by an immunohistochemical study, its degenerative or tumoral nature. 7 cases of LLU were identified represented by 2 pure Lipoma and 5 Lipoleiomyoma. We performed an immunohistochemical study including anti-vimentin, anti-smooth muscle actin, anti PS-100, anti-desmin, anti-factor VIII and anti-HMB- 45. The results were correlated with the pathogenesis of this lesion. Immunohistochemical analysis showed an expression of PS 100 only in lipocytes whereas leiomyomatous cells express only smooth muscle actin. Our study supports the benign tumoral nature of the fatty uterine lesions. Lipoleiomyomatous cells may originate from the transformation of a totipotent mesenchymal cell and not from a degenerative process

Review of 32 gastro-intestinal stromal tumours with CD117

The Aim of this study is to review clinical data, histological and immunohistochemical findings and prognosis of stromal gastrointestinal tumors. A retrospective Study of 32 cases of stromal gastrointestinal tumors diagnosed in the Department of Pathology of Mongi Slim Hospital of Tunis from 1991 a 2004. The average age of the patients was of 54, 4 years, equal for sex. Tumors were essentially gastric [50%] and of the small intestine [37, 5%]. All the patients had surgical treatment. Gastro-intestinal Stromales Tumors or GIST represent the most frequent stromale tumor with 56, 2% of cases. After immunohistochimestry study, using CD117, this revision allows better management of GIST. Glivec +/- is the standard treatment of advanced GIST

[Pulmonary lymphangiomatosis revealed by an interstitial syndrome in a young adult]

The p73 gene encodes a nuclear protein that is highy homologous to p53. p73 also shares some common functions with p53 protein indicating that p73 gene is a p53-like tumor suppressor. In this study, we examined by immunohistochemistry the p73 expression on 120 cases of colorectal carcinomas and evaluated its implication in carcinogenesis. Retrospective study. The results show an increase of intensity and distribution of p73 in common adenocarcinoma from the normal mucosa, to primary tumors and to metastases. However, in mucinous adenocarcinomas, immunostaining of p73 decrease in primary tumor and completely diseappears in isolated cells and metastases compared with matched normal mucosa. These observations are further reinforced by the fact that in adenocarcinoma with mucinous component less than 50%, the positivity of p73 persist in well-differentiated areas and dramatically decreases or completely deseappears in mucinous areas. In conclusion, p73 would be a prognosic marker for the common adenocarcinomas and an ethiopathogenic factor for the mucinous subtype

[Gastrointestinal stromal tumor: epidemiology and outcome study in 40 cases]

The aim of this study was to analyze epidemiology and outcome of 40 patients with gastrointestinal stromal tumor [GIST] expressed CD117. All epidemiological data [age, sex, location] and survival data were analyzed retrospectively. The tumors occurred in 17 men and 23 women. Stomach was the most common site of localization [47.5%]. Of the 37 patients without Gleevec treatment, 18 benign cases [66.6%] showed long-term survival [2 to 8 years] and 9 malignant cases [33.3%] were diagnosed. 10 cases were still being in followed [< 2 years]. Gastric tumor's survival was better than extragastric tumor's survival without statistically significance [p>0.05]. Our experience confirms that GIST is an aggressive tumor. 33.33% of them are malignant with recurrence or metastatic potential. Additionally, epidemiologic factors [age, sex and location] do not have a predictive value

[Nasosinusal sarcoidosis: 2 cases. a report of 2 cases]

Nasosinusal sarcoidosis is a rare non caseating granulomatous disease. It may be inaugural, isolated or associated with multisystemic sarcoidosis. We report two cases of nasosinusal sarcoidosis associated to multisystemic sarcoidosis. Both patients were females aged over 43 years. In one case, the primary symptom was a nasal obstruction. Tomodensitometric and guided biopsy findings provided the main diagnostic criteria. Anti-malaric treatment was prescribed in both cases. Stabilisation of the lesions was noted. We tried to reveal through this study the diagnostic and therapeutic difficulties of nasosinusal sarcoidosis

Teratome kystique mature de la trompe a propos d'une observation

Primary teratomas of the fallopian tube are extremely uncommon. Only about 50 cases have been reported in the literature. They occur usually in the fourth decade. There association with nulliparity and reduced parity has been noted. Many have been discovered incidentally and none has been diagnosed preoperatively. The majority are cystic, show great variation in size and are commonly located in the ampulla or the isthmus. They can be intraluminal, attached to the serous surface by a pedicule and rarely intramural. Histologically they are similar to teratoma of the ovary and elsewhere. We describe a mature cystic teratoma of the fallopian tube found incidentally in a 35-year-old woman operated for suspicion of ectopic tubal pregnancy. The feature of benign teratoma of the fallopian tube is discussed

[CD117 contribution in the diagnosis of mesenchymal tumors of the digestive tract]

Gastrointestinal stromal tumor [GIST] is a new distinct entity defined as CD117 or c-kit positive mesenchymal tumors, originaling in gastrointestinal pacemaker cells known as interstitial cells of Cajal. This study evaluate the percentage of GIST previously diagnosed as mesenchymal tumors in our hospital during 11 years. A total of 30 surgically resected gastrointestinal tumor specimens were collected from January 1990 to December 2000 in the pathology laboratory of La Rabta Jospital. Immunohistochemical studies were performed on these tumors with antibodies of CDI 17, smooth muscle actin [SMA] and protein S-100. Among the 30 tumors, 26 [86.6%] were CD117 positive and were classified as gastrointestinal stromal tumors. Among the 26 GIST, SMA was positive in 11 tumors [42.3%], 6 tumors [23%] expressed protein S- 100. The 4 tumors classified as non-GIST were leiomyomas with the following immunohistochemical characteristics: CD117-negative with strong SMA-positive and protein S100 negative status. The majority [86.6%] of mesenchymal gastrointestinal tumors were GIST, except for a smalls groups of smooth muscle tumors

[Early gastric cancer - two case reports]

Gastric cancer is a serious disease with a high mortality rate. Early diagnosis of the disease improves its prognosis. We report two cases of early gastric cancer and we specify the clinical, endoscopic, histologic and therapeutic aspects of the disease. This study is about two female patients, respectively, 36 and 70 years old. The diagnosis of early gastric cancer was based on pathologic examination of the resected stomach.The two patients are in remission 2 years and 6 months later, respectively. The diagnosis of early gastric cancer is often made on nonspecific symptoms. Oeso-gastro-duodenoscopy shows gastric mucosal anomalies. Pathologic examination of gastric biopsies confirm the diagnosis of adenocarcinoma. Endoscopic ultrasound is essential; it specifies the submucosal infiltration and evaluates the lymph node invasion. Surgery is the primary treatment but in some cases endoscopic mucosal resection provides good long-term results. Early diagnosis of adenocarcinoma improves the prognosis of the disease, which remains poor nowadays

Dyskeratomie verruqueux ou "Dyskeratomie folliculaire": aspects anatomo-cliniques d'une nouvelle entite

Warty dyskeratoma is a rare, benign, epithelial tumor characterized by a variable clinicopathologic spectrum. In all cases, lesions revealed foci of acantholytic dyskeratosis. Case report: A 74-year-old man has for two year developed a single small nodule with a hyperkeratotic area on the scalp. Histopathology revelead a warty dyskeratoma. Discussion: Warty dyskeratoma is an epithelial tumor. Histopathology is important for the diagnosis. On the basis of our findings and from the literature, we propose to discuss the nosologic problem of this entity

[Menetrier's disease and gastric carcinoma]

The authors report 4 cases of Menetrier's disease associated with gastric adenocarcinoma and one case of low-grade dysplasia. The patients [3 men and 2 women] were aged between 53 and 81 years. In three cases the diagnosis was established by histological examination of the exicised tumor; in one case it was based on microbiopsy specimen; and in another case on a gastric tissue specimen. The authors review the anatomo-clinical features of this association and raise the problem of the relationship between Menetrier's disease, dysplasia and cancer

Tumeur papillaire solide et kystique du pancreas

solid cystic papillary tumors of the pancreas are rare. This tumors were seen in young women. They have distinct clinic pathologic characteristics. Their prognosis is excellent because of their low grad of malignancy. The tumor was encapsulated and have favorable prognosis after complete surgical resection. We report one case of solid cystic papillary tumor of the pancreas occuring in female patient who are 20 years old. This observation have been a pre operative morphologic and ultrastructural study [CT, Ctscan, EE, IRM and immunohisto-chemistry study] who permetted to elaborate diagnosis