[Descriptive epidemiology of extrapulmonary hydatid cysts: a report of 265 Tunisian cases]

Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body. The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature. Aretrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken. There were 101 male and 164 female patients [sex ratio M/F= 0, 61] ranging in age from 2 to 84 years [mean age = 38, 7]. In our series, hydatid cysts involved mainly the kidney [24, 1%], the central nervous system [22, 6%], the liver [19, 6%] and the spleen [11, 3%]. The other less frequent sites included the peritoneum [n = 9], heart [n = 9], bone [n = 6], adrenal gland [n = 4], epiploon [n = 4], orbit [n = 4], ovary [n = 3], prostate [n = 2], bladder [n = 2], breast [n = 2], Douglas' cul-de-sac [n = 2], diaphragm [n = 1], testis [n = 1], broad ligament [n =1], mediastinum [n = 1], nasal cavity [n = 1], soft tissue [n = 1], abdominal wall [n = 1], parotid gland [n = 1], psoas muscle [n =1], synovia [n = 1], thymus [n =1] et le pancreas [n = 1]. In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank

Frequency and predictive factors of granulomatous hepatitis in patients with peritoneal tuberculosis

The aims of our study were to determine the frequency of granulomatous hepatitis in patients with peritoneal tuberculosis, to identify factors for high risk and whether it is associated with higher frequency of antituberculous treatment side effects. We carried out a prospective study on patients with histologically proven peritoneal tuberculosis between January 1996 and December 2005. We performed a liver biopsy in all the patients before starting the antituberculous treatment. Granulomatous hepatitis was systematically searched in all patients. The study was conducted in 52 patients, 9 men and 43 women of median age of 35,5 years. A granulomatous hepatitis was seen in 24 patients [46%]. In univariate analysis the factors associated with a high risk of liver involvement were a higher level of gamma-G1utamyl transpeptidase [44.5 + 36.8 lU/l vs 23.3 + 9.28 lU/I p=0.005], a higher level of phosphatases alkalines [233.9 + 96.6 lU/l vs 189.4 + 49.9 lU/l p=0.03] and a lower level of cholesterol [1.22 + 0.2 g/l vs 1.56 + 0.3 g/l p<0.0001]. In multivariate analysis, only a cholesterol level lower than 1,31 g/l was significantly associated with a granulomatous hepatitis [p=0.006 OR [IC95%]: 0.10 [0.02-0.52]]. We have found a frequent liver involvement in the case of peritoneal tuberculosis [46%]. Cholesterol level lower than 1,31 gr/l was an independent predictor of granulomatous hepatitis in patients with peritoneal tuberculosis. We suggest, in this case, that percutaneous liver biopsy can be considered as an alternative to laparoscopy

[Central nervous system dysgerminoma. A clinicopathological study of 3 cases]

Intracranial germ cell tumors are rarely seen and typically localize in the pineal or suprasellar region. The largest category of germ cell tumors is dysgerminoma. To describe clinicopathological features and immunohistochemical profile of dysgerminomas. We report three cases of central nervous system dysgerminomas. There were two young women and a man who were 6, 11 and 23 year-old. They presented with symptoms of insipidus diabetes [n=3] with association to visual field defects in the third case. Radiological findings showed a supra seller lesion in two cases. Double localization in the pineal and suprasellar regions was seen in the third case. Histologic examination and immunohistochemical study of surgical specimen were consistent with primary central nervous system dysgerminoma

[Infantile desmoplastic fibroma of the maxilla]

Infantile desmoplastic fibromatoses are benign fibrous tissue tumours, non -metastasizing but locally aggressive and with high likelihood of recurrence. Many cases occur in young children between 18 months and 3 years and commonly present as painless mass of the submandibular region. The maxilla is rarely involved. Through this report and a review of literature, we are going to study clinical, pathological and prognostic characteristics of this affection. We report here a case of an aggressive desmoplastic fibroma arising in a 20-months-old infant originating in the left anterior maxillary wall. Clinical examination of the face revealed a non tender, firm, expansion of the left maxilla of 2.5 cm of diameter. The diagnosis of DF of the maxilla was made on the basis of histological features on biopsy specimen. No other location of the fibromatosis was found. The child had a favourable course. DF is an intraosseous, non metastasizing and locally aggressive fibrous tumour. Although its benignity it could engage vital prognosis since it can extend into vital organs