[Immunohistochemical analysis of mismatch repair proteins in colorectal adenomas]

The deficiency of mismatch repair system is one of the main pathways in colorectal cancer. This system consists mainly of four proteins: MLH1, MSH2, MSH6 and PMS2. Colorectal cancer develops in the majority of cases from precancerous lesions called adenomas. Only few studies have reported on the deficiencies of these proteins in adenomas. In this study we used immunohistochemistry staining in colorectal adenomas to assay functional status of MLH1, MSH2, MSH6, and PMS2 proteins. 102 adenomas from 93 patients were collected in our institution during six years [2007-2012]. The immunohistochemical technique was performed with 4 antibodies: MLH1, MSH2, MSH6 and PMS2. The loss of expression was retained if adenomatous cells were not stained with positive internal control. Staining was considered as abnormal if nucleus of adenomatous cells showed low nuclear staining and / or heterogeneous one, while positive internal control had normal staining. Loss of expression of MSH2 and MSH6 in adenomatous cells was found in only 1 case which was a tubular adenoma 3mm high-grade dysplasia. Abnormal staining of the adenomatous cells was noted in 23 cases [22.5%] for MSH2 and in 8 cases [7.8%] for MSH6. No cases showed loss of expression of MLH1 and PMS2. Abnormal expression of MSH2 and MSH6 was not correlated with sex of patients, the location of the adenoma, its grade of dysplasia and its histological type. Loss of Mismatch repair proteins expression is a rare event in adenomas. However, the abnormal expression levels are higher in our study compared to those reported in the literature. This could reflect a higher rate of microsatellite instability in our patients. Multicenter and larger studies with molecular biology techniques are needed

[ exceptional hepatic tumor]

Hepatic localization of non Hodgkin's lymphoma is generally secondary. Primary localizations are rare.To report a rare case of primary hepatic lymphoma particular by its association with dermatopolymyositis. A 55-year-old woman with a past medical history of dermatopolymyositis diagnosed one year before presented with abdominal pain and fever. Laboratory tests showed pancytopenia. Radiologic examination revealed multiple hepatic masses. Surgical biopsy revealed a large B cell hepatic lymphoma. No other localizations were found so the diagnosis of primary hepatic lymphoma was retained. The patient died after a few days due to a severe sepsis. Primary hepatic lymphoma is a rare tumor with a bad prognosis. Its diagnosis is based on histologic examination. Treatment of these tumors remains non consensual

[Microcystic serous pancreatic cystadenoma]

The pancreatic cystic serous neoplasms are divided into two categories: benign serous cystadenoma [SCA] and malignant serous cystadenocarcinoma. Furthermore, based on the macroscopic appearances, SCAs are subdivided into serous microcystic adenomas [SMAs] and serous oligocystic or macrocystic adenomas. Report of a new case of SMA in which we emphasize on the diagnostic difficulties encountered against such tumor despite its relatively radiological easiness compared to the other variants. We report the case of 84 year-old-woman with a microcystic serous cystadenoma of the pancreas which was identified on pathologic examination of the surgical specimen, after unconclusive abdominal ultrasound and computed tomography [CT]-scan. This case describes this rare entity and emphasizes that the diagnosis of such entity is still based on pathological examination after tumor removal

Adreno-cortical oncocytoma: a case report

Adrenal oncocytoma is a very rare lesion, non functioning and benign in most cases. Only 46 cases have been reported in the medical literature. This study aimed to report a new case of adrenal oncocytic tumor with uncertain malignant potential. A 72 year-old- man, consulted for renal fossa pain. Ultrasonography and omputed tomography scan revealed a large mass in the right adrenal gland with extension to the right kidney. A right adrenalectomy and nephrectomy was performed. The diagnosis of adrenal oncocytoma with malignant potential was confirmed by pathology. Patient had a well recovery and left hospital on the fifth day post operatively. He was followed up for 8 months, no tumor recurrence detected. Adreno cortical oncocytoma is a rare tumor. The majority of reported cases had good prognosis

[Multilocular cystic renal cell carcinoma]

Multilocular cystic renal cell carcinoma is an uncommon variant recently described of renal cell carcinoma. Analyze clinicopathological features, imaging findings and prognosis and therapeutic options of this tumor. The authors reported two cases of multilocular cystic renal cell carcinoma arising in 68 and 39 year old men. They were admitted with pain in the lumbar region and/or haematuria. The imaging findings were a renal neoplasm with cystic and solid areas. The pathologic findings confirm the diagnosis of multilocular cystic renal cell carcinoma. Multilocular cystic renal cell carcinoma, usually identified at earlier stages, had slower growth rate and was therefore associated with a better prognosis and longer survival than conventionnal renal cell carcinoma

[Parotid basal cell adenoma of membranous type]

Basal cell adenoma [BCA] is a rare benign neoplasm characterized by the basaloid appearance of the tumour cells and the lack of myxochondroid stromal component present in pleomorphic adenoma. We report a case of basal cell adenoma of membranous type, highly suspected of malignancy because of the presence of mediastinal lymph nodes and pulmonary nodules which finally were related to an associated sarcoidosis. Our patient was an 80-year-old woman who presented a swelling of the right parotid two years ago. The clinical examination revealed a solid, indolent and mobile mass. A chest radiography noted mediastinal lymph nodes. The CT-scann confirmed the presence of mediastinal and tracheal lymph nodes with pulmonary nodules. So the diagnosis of metastatic malignant salivary gland tumor was suspected. Finally, the histological examination concluded to a basal cell adenoma of membranous type with sarcoidosis granulomas in the parotid and in the lymph nodes. The BCA is a benign tumor located generally in the parotid gland. When the malignancy is suspected, like in our case, this tumor must be differentiated from the basal cell enocarcinoma using histological criteria

[Diagnostic value of immunohistochemistry in ovarian sex cord-stromal tumors]

The ovarian tumors' diagnosis is bused on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis. The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis. We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors. The average age of our patients was 51.3 years with an average size of 8,4 cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and 5-100 protein. The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors

[Signonasal leiomyoma: an exceptional localization]

Most of the sinonasal tumours are of epithelial origin. Leiomyomas are very uncommon in the upper respiratory tract and extremely rare in the nasal cavity and paranasal sinuses. They account for less than 2.5% of the mesenchymal neoplasms of the sinonasal tract and the nasopharynx. Report of a new case which will be added to the 30 cases of primary sinonasal leiomyogenic tumours reported in the litterature. The clinical and pathological characteristics of this tumour will be discussed. We report a case of 48-year-old woman complaining of nasal obstruction corresponding to a polypoid lesion of the sinonasal cavity. The histological examination of the removed mass concluded to a leiomyoma. Leiomyoma in this location has no specific physical or radiological findings. Only the histological examination can definitively made the correct diagnosis

[Solid pseudopapillary tumors of the pancreas: a pediatric case report]

Solid pseudopapillary tumors of the pancreas are extremely rare and mostly seen in young females. It is often diagnosed incidentally or during investigations of gastrointestinal complaints. Report of a pediatric case of this tumor. We report the case of a 15-year old teenager who presented with painful abdominal tumefaction. Imaging findings were a 12 cm solid and cystic mass originating from the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. Pathologic examination concluded to solid pseudopaprillary tumor. Evolution was favorable with no recurrence 18 months after surgery. Histological examination confirms the diagnosis and allows, with the help of immunohistochemical study, to rule out some differential diagnoses such as pancreatoblastoma, acinar tumors and endocrine tumors. Prognosis of solid pseudopapillary tumors of the pancreas is excellent after radical resection and recurrences are rarely seen

[Histopathological study of gastric polyps. a report of 65 cases]

In a retrospective study of the specimens of gastric polypectomy, carried out between January 1992 and December 2002. we analysed the demographic and histological aspects of 65 polyps. This study revealed hyperplastic polyps in 66%, ade-nomatous lesions in 9.2%, Peutz-Jeghers polyps in 7.7%, inflammatory fibroid polyps in 6.15?, two cases of focal foveolar hyperplasia [3%]. two cases of Brunner's gland heterotopia [3%], 1 pancreatic heterotopia [1.5%], 1 fundic gland polyp [1.5%] and 1 carcinoid tumor [1.5%]. All adeno-mas and two Peutz-Jeghers polyps include intraepithelial neoplasia. Moreover, we identified a case of Brunner's gland heterotopia, which contain a focus of plane tubular adenoma with high-grade intraepithelial neoplasia. Other lesions were found within the polyps or into the surrounding gastric muco-sa, such as intestinal metaplasia and Helicobacter Pylori gastritis. This work allowed us to recommend complete removal of gastric polyps and the realization of biopsies of the non-polypoid gastric mucosa in the search of intraepithelial neo-plasia or other lesions with malignant potential

[Prognostic value of clinicopathologic factors in superficial bladder: a retrospective analysis of 59]

To study, through a series of superficial bladder tumors, the prognostic factors of recurrence and tumoral progression. this is a retrospective study of a series of 59 urothelial tumors of the bladder at stage pTa or pTl. The following parameters were considered: age, sex, treatment, stage and grade. The chi square test was used in search of a correlation between the different parameters and the course [recurrence and progress] of the disease. A multivariate analysis was undertaken by integrating factors correlated with the course. Thirty two tumors [54%] had recurred versus 27 [46%] without recurrence. Light tumors [25%] progressed in grade and 4 [12,5%] had become infiltrative. Age beyond 65 years. tumoral size > 3 cm and rnultifocality were predictive factors of recurrence with a relative risks of 2.36, 3,28 and 3,88 respectively. In a multivariate analysis, these factors remained significant with adjusted relative risks respectively of 1,36, 1,6 and 1,7

[ particular hepatocellular carcinoma combining the ordinary and the fibrolamellar variant]

Fibrolamellar carcinoma [FLC] of the liver is a rare variant of hepatocellular carcinoma [HCC] occurring on non cirrhotic liver. Since its first description by Hugh Edmondson in 1956, 200 cases of FLC have been reported in the literature, but only some cases describe the association of the ordinary HCC with the FLC within the same lesion. We report in this study the case of a 14-year-Old female patient with a hepatic mass whose radiological aspect evoked a nodular and focal hyperplasia. Histologically, this tumor was composed of area of FLC mixed with ordinary HCC. Staining for cytokeratine 7 was positive in the FL component and negative in the ordinary HCC component