HIV and AIDS: global summary and basic facts

Investing in AIDS is leading to concrete outcomes with an optimistic view to end this epidemic. Unfortunately, achievement and progress related to this disease are not fairly disseminated among high risk populations. There is a need to reform policies and punitive laws, in addition to ensuring adequate access to treatment without forgetting the importance of addressing stigma and discrimination, implementing an efficient awareness campaign and prevention program and services taking into consideration specificities of each region. HIV program must be integrated within the national disaster preparedness and response plans. International and national efforts need to rise, especially from the government side along with the civil society to efficiently overcome health threatening conditions facing vulnerable populations. This article addresses main findings and limitations in the region and serves as a reminder on basic facts versus myths and a global summary on HIV/AIDS

[ 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

[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

[Conservative treatment of breast cancer - study of 160 cases]

To study the impact of conservative treatment of the breast cancer on overall survival and recurrence free survival and trying to determine the prognostic factors. With a retrospective study over a period of six years [1995 to 2000], about 160 patients diagnosed and treated in Salah Azaiz Institute for early breast cancer. Only 9% of patients had a breast conserving therapy for breast cancer. The mean age was 47 years. The most frequent motive of consultation was breast nodule. The tumour was located in the upper outer quadrant in 43% of the cases. Local excision of the tumour with re excision of the tumour bed associated with lymph node dissection were performed in all patients. Invasive ductal carcinoma was found in 83% of the cases, grade I in 23% of the cases and grade III in 32% of the cases. On the other hand, 35.4% of the removed axillary lymph nodes were involved. Hormone receptors were positive in 61% of the tumours. The follow up of the patients was from 18 to 98 months with a mean period of 55 months. The 5 year overall survival was 92% with recurrence free survival of 94%. The recurrence rate was 3.7% within a period of 5 to 60 months. The 5 year metastases free survival was 82% with metastases rate of 10%. The most frequent localization was the bone [43.5%]. The mean delay of metastases went from 11 to 62 months. The univariate study of prognostic factors showed that histological tumour size had a significant impact on metastases free survival. The invariant study of the prognostic factors on overall survival showed that the tumour size < 3 cm, the absence of the lymph node involvement [P = 0.02], positive hormone receptors [P=0.02] represented good prognostic factors. The rate of conserving therapy remains low in our country, and this is because of the importance of the tumour size at the diagnosis, with survival rate and locoregional recurrence rates similar to the literature data. The augmentation of the number of the patients that can benefit with conserving therapy must imperatively pass through the development and the promotion of early diagnosis and screening by mammography

[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

[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

[Breast cancer prognosis in Salah Azaiez Institute of Cancer, Tunis]

We estimated survival rate at 9 years of all [470] women with breast cancer diagnosed at Salah Aza‹ez Institute of Cancer in Tunis to identify the main prognosis factors. Data were collected on residence, socioeconomic level, circumstances of discovery of the tumour, histological type, tumour size, presence of metastases, extension of the tumour, treatment and survival. Comparison of survival curves was done with Log Rank test. Cox model was used for multivariate adjustments and calculation of the hazard ratio [HR] [relative risk of death]. There was a survival rate of 61% at 5 years and of 51% at 9 years. Tumour size > 5 cm was significantly associated with lower survival as was capsular rupture. After stratification for tumour size and age, only surgery and radiotherapy were significantly associated with improved survival

[Recurrent obstructions after resonance stent placement in the treatment of ureteral compression from malignant disease]

Background: The Resonance ureteral stent is a newly developed all-metallic double-pigtail ureteral stent allowing a palliative diversion on a patient with malignant ureteral obstruction

Aim: To define selection criteria of good candidates for Resonance stent

Case: A 62-year-old woman was admitted to the emergency department with complaining of severe right flank pain and anuria. Twelve days earlier, we had placed retrogradely a ureteral metallic Resonance stent [Resonance: Cook Ireland Ltd, Limerick, Ireland] for the treatment of a ureteral compression from pelvic recurrence of an appendical colloid mucosal carcinoma in a solitary functionning right kidney. A percutaneous nephrostomy catheter was placed, and an antegrade nephrostogram demonstrated complete distal ureter obstruction. The patency of the ureteral stent was restored spontaneously and then, nephrostomy catheter was removed. Two weeks later, she presented with obstructed ureteral stent. Percutaneous nephrostomy was performed and Resonance stent was removed definitively. Ureteroscopy with biopsy confirmed the tumor extension into the ureteral lumen

Conclusion: The risk of subsequent obstruction after Resonance metallic ureteral stent placement is real. Patients with intra-ureteral tumour extension are presumably not good candidates for Resonance stent management

[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

Cardiac metastasis of leg liposarcoma. A case report

Cardiac tumors are rare. In autopsic series, their incidence is 0.02 - 0.03%. Liposarcoma is an exceptionnel cause of cardiac metastasis. We report the case of a 55 years old patient, operated for multiple localisations of liposarcoma [left leg, left arm, abdomen]. As well as, he has a vertebral metastasis treated by radiotherapy. Two months later, the patient consulted for dyspnoea. A cardiac ultrasound tomography showed dilated right cavities with a volumineous intra ventricular mass. A thoracic computed tomography was showed a tissular intracardiac mass. The patient was operated in a cardiovascular surgery service, but died in post operative period. The purpose of this study is to specify the cardiac metastasis incidence, the diagnostic methods and therapic modalities

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

[Pseudo tumoral splenic tuberculosis - a case report]

Splenic tuberculosis is uncommon. It is reported in disseminated tuberculosis syndrome and can be a symptom of AIDS. Pseudo tumoral forms are rare. Diagnosis is difficult on the basis of the clinical and radiological presentation. Histological analysis confirms the diagnosis. We report the case of a 30 years old women treated for nodal tuberculosis. After 4 months of treatment, she consulted for non specific abdominal pain without other signs. Radiological exploration concluded for nodular spleen lesions. The patient had gone under a median laparotomy and a splenectomy was performed for multiple abscess in the spleen. Pathological exam of the spleen confirm that it was splenic tuberculosis