Diagnosis of lymph node tuberculosis using the GeneXpert MTB/RIF in Tunisia

Introduction: GeneXpert MTB/RIF is a fully-automated diagnostic molecular test which simultaneously detects tuberculosis [TB] and rifampicin [RIF] drug resistance. The purpose of this study is to evaluate the performance of the GeneXpert MTB/RIF test for the detection of Mycobacterium tuberculosis complex [MTBC] in lymph node specimens and to show the place of Mycobacterium bovis as a major cause of TB lymphadenitis

Material and methods: This study was conducted simultaneously in the National Reference Laboratory for Mycobacteria of Ariana and the Central Laboratory of Sfax, from January to December 2013. In total, 174 lymph node specimens were processed simultaneously for Ziehl-Neelsen, auramine and immuno-histochemical staining. Conventional culture on both Lowenstein-Jensen and liquid medium [Bactec MGIT 960 BD system] and the new molecular-based GeneXpert MTB/RIF assay system were performed. Positive cultures were confirmed using molecular identification [Genotype MTBC Hain Lifescience]

Results: Among the 174 samples tested, the GeneXpert detected the DNA of MTBC in 134 samples [77%]. Standard bacteriological assays, including AFB microscopy and culture, were positive, respectively, in 41 [23.6%] and 79 [45.4%] specimens. M. bovis was isolated in 76% of positive cultures. GeneXpert sensitivity and specificity results were assessed according to smear and culture results, clinical and histological findings. The sensitivity and specificity of the Xpert assay were 87.5% [126/144] and 73.3%, respectively

Conclusion: The implementation of the GeneXpert MTB/RIF assay may dramatically improve the rapid diagnosis of lymph node TB

Clear cell carcinoma of the uterus

The aim of this study was to determine the characteristics and outcome of patients presenting with clear cell carcinoma [CCC] of the endometrium treated in a single institution. We reviewed the records of patients treated in the Salah-Azaiz institute for CCC of the endometrium. A histopathological stage was retrospectively assigned to these patients according to the FIGO classification and was compared to the clinical stage. Pathological features were studied in order to determine predictive factors of extrauterine disease extention and failure patterns. 12 patients were included in the study. The mean age at diagnosis was 64 years [50 to 84 yrs]. Upstaging after surgery was found in 9 patients. 9 patients had extrauterine extension. Deap myometrial invasion was not correlated with extrauterine extension. After a median follw up of 32 months, 4 patients presented with recurrences: one vaginal recurrence, two cases of pelvic and abdominal recurrence and abdominal recurrence in one patient. All recurrences occurred during the first year after surgery. Tumor recurrence was located within the radiation field in one case. Two paients with abdomino-pelvic recurrences progressed despite the association of surgery, radiation therapy and chemotherapy. Extrauterine extension is frequent at diagnosis and not correlated to classical risk factors observed in endometrioid carcinoma. A comptlete surgical staging is necessary for adjuvant treatment. Locoregional and distant recurrences are frequent and have a poor outcome