Imaging of pseudoangiomatous stromal hyperplasia of the breast

Rare benign breast lesion that commonly affects premenopausal women. It is a myofibroblastsproliferation around optically empty slots giving a false appearance of vascular network of its name [pseudoangiomatous] hyperplasia where there is absolutely no vascular injury. It appears as a single mobile breast nodule, firm, usually unilateral and as a net opacity with regular contours and without microcalcifications.]V1. We present two lesions that were classified as malignant in the initial control by mammography, wich led to a needle biopsy.But no any histological sign of malignancy was shown. The diagnosis requires ultrasound-guided percutaneousbiopsy or stereotacticbiopsy for histological study. The false appearance of vascular network can mimic on a first reading a low-grade angiosarcoma. Then, immunohistochemistryis needed to demonstratemyofibroblastic origin. The resection must be complete with a long-term surveillance because of the risk of recurrence of up to 20% of cases when resection is not total. The diagnostic alternative is currently provided by the ultrasound guided percutaneous biopsy or stereotactic biopsy, which determines the nature of the lesion and rules out malignancy, such as angiosarcoma, in order to avoid unnecessary surgical biopsies

[ imaging findings of the carotid chemodectom]

The carotid body tumor, which arises from its chief cells [glomus type 1], is the most common paraganglioma of the head and neck [up to 50%]. The following case report is particularly useful for daily practice; the patient has surgical history of tiroid neoplasm which requires a thorough diagnosis, in order to determine an accurate follow-up. This tumor is in most cases clinically silent and is detected incidentally at imaging study during evaluation of patients with unrelated symptoms such as painless, slowly growing lateral neck mass, dysphagia, sleep apnea, and paresia or atrophy of the tongue. According to its appearance, precise non-invasive imaging techniques may allow the radiologist to reach the correct diagnosis and treatment

[Pheochcromocytoma, report of 10 cases]

The pheochromocytoma is a rare endocrine tumor, issued from the chromaffine surrenalian or extra-surrenalian tissue. We report a retrospective study of 10 cases of pheochromocytoma collected during a period 3 years. Our study concerned 3 men and 7 women, with an average age of 32, 5 years. Revealing symptomatology was dominated by an arterial hypertension [8 cases]. The triad of Menard [headaches, sweating and palpitations] was found in 6 cases. The biological assessment found a rise in the urinary catecholamine. Complementary exams [ultrasonography, tomodensitometry, magnetic resonances] were usefull for the location of the tumor. The adenalectomy realised by transperitoneal under costal way was realised in all the cases. Histological examination confirmed the diagnosis. The pheochromocytoma is a neuroendocrine tumor of neuroectodermic origin. The clinical and biological presentations depend on the importance of the hypersecretion of catecholamines. The treatment is surgical. The objective of this study is to insist on the rarity of this pathology, the diagnostic difficulties, the severity of this pathology and curability of the benign forms

[Squamous cell carcinoma of the pelvis presenting as pyonephrosis. A case report and review of the literature]

Squamous cell carcinoma of the renal pelvis is a rare tumor with a poor prognosis, mainly occurring in patients with neglected and secondarily infected pyelocalyceal stones. We report a new case of a 45-year old man who presented with features of pyonephrosis and was subjected to nephrectomy. Post-operative histological evaluation revealed an unsuspected squamous cell carcinoma of the renal pelvis. The patient died 3 months after the operation. Based on our observation and a review of the literature, we discuss the etiopathogenesis, histological, clinical and therapeutic aspects of this pathology

[Vaginal flap urethroplasty in the treatment of urethral destruction of obstetric origin]

Objective: Urethral destruction of obstetric origin is frequent in North Africa. The objective of this study was to evaluate the results of urethral repair by vaginal flap in women affected by urethrovaginal fistulae

Patients and Methods: From January 1998 to December 2001, five patients were subjected to urethroplasty by vaginal flap mobilized from the anterior vaginal wall. The patients' age ranged from 30 to 45 years; all were primiparous with obstetric urethrovaginal fistulae revealed by permanent urinary leakage. The closures were realized in two continuous sutures of PDS 4/0 on a urethral catheter of 16 Fr. The ablation of the catheter was practised on the 10th postoperative day

Results: Urinary continence was achieved in four patients. The remaining patient had stress urinary leakage corrected by colposuspension. Recovery with good results was noted in 80% of the cases

Conclusion: This technique allowed us to achieve an improvement of the quality of urethral repair. Being an easily performed technique, it allows at the same time to achieve elegant, effective and reliable results

[Fracture of the corpus cavernosum: report on 123 cases]

Objective: To analyze the diagnostic and therapeutic aspects of fracture of the corpus cavernosum and compare our results with those in the literature

Patients and Methods: Between January 1976 and June 2002, 123 cases of fracture of the corpus cavernosum were treated at our department. The mean age of the patients was 25 years. In the majority of cases [71.5%], fracture of the penis occurred by forced manipulation of the erected penis. The diagnosis was based on clinical examination. The patients were treated surgically by repair of the tunica albuginea, mostly [74 cases] after degloving of the penile skin. One case of ureteral rupture was encountered after fracture of both corpora cavernosa

Results: In 95 patients, the postoperative outcome was satisfactory. However, 8 cases of fibrous plaques and 4 cases of penile curvature were encountered. None of our patients experienced postoperative erectile dysfunction

Conclusion: Fracture of the corpus cavernosum is a pathology which remains quite rare. The diagnosis is based on clinical examination and treatment is surgical in the majority of cases. The outcome of the treatment of such fractures is usually satisfactory provided the patients present at an early stage

[Primary immunodeficiency in children in Casablanca: a 73 cases report]

Primary immunodeficiencies [PID] seem to have two particularities in the Maghreb countries: a higher frequency than in the occidental countries and a higher proportion of deficiency of HLA class II antigens. Patients and method: a four-year study reports 73 PID cases between 1997 March and 2001 February in the Clinical Immunology Unit of the Casablanca Children Hospital. These 73 cases were diagnosed, according to the WHO criteria, among 358 children with recurrent and/or severe infections. They had an immunological assessment: tuberculin IDR, blood cells, serum immunoglobulin A G and M, lymphocytes classes. we found 18 combined immunodeficiency including 5 deficiencies of HLA class II antigens, 18 antibody defects, 17 complex immunodeficiencies including 11 ataxia-telangiectasia syndromes, 13 PID associated to an other disorder including 4 hyper IgM syndrome, 6 phagocyte disorders and one complement defect. Because of their high cost, the intravenous immunoglobulins were used in only 29 children and the bone marrow transplantation is not available in our country. Twenty six children died in this study. Comments: as in Tunisia, our study confirms the high frequency of combined and complex PID in comparison to the occidental studies, and we have to develop the PID diagnostic and treatment resources in our country

Pregnancy and delivery among adolescent

The high risk of adolescent pregnancy is due to morphologic, socio-economic and psychologic factors and to the lack of prenatal supervision. In a retrospective study about 508 adolescents, we tried to emphasize the specific aspects of moroccan adolescent women. The unmarried ones represented 15%, mainly very young girls. The incidence of the preclampsia was 6%. The rate of premature delivery was 8%. These complications seen to be due to the lack of prenatal supervision and to the unmarried status of the adolescent. The delivery was most often eutocic. The instrumental extraction was necessary in 20,43% of the cases especially because of bad maternal cooperation at the expulsion. The caesarian section has been practiced in 5.12% of the cases. The average weight of newborns of unmarried women was by 280 grammes lower compared to newborns of married women. The weak neonatal weight [2500 grammes] was noticed in 12% of the cases mainely related to prematurity. The perinatal mortality represented 36.3% births. The pregnancy of adolescents doesn't seem to be subjet to high medical risk, provided that it takes advantage of prenatal follow up and adequate supervision