Maxillary alveolar bone ridge width augmentation using the frame-shaped corticotomy expansion technique.

Maxillary alveolar ridge expansion performed by intercortical bone splitting is a seducing alternative surgical procedure for alveolar bone widening. The aim of this technique is to gain enough bone width to be able to place a dental implant simultaneously. This technique avoids a second surgical site for bone graft harvesting. However there are risks of surgical failure caused by unintended bone fracture during expansion and implant placement, or by insufficient bone widening for implant insertion. To limit these risks, we have published expansion techniques using various corticotomies. These corticotomies are achieved according to bone anatomy, most of them remote from implant position. Bone fractures are guided during the bone expansion and the implant placement, avoiding cortical bursting. Wider and safer bone movements can be achieved allowing to place the forecasted implant with adequate dimensions, axis, and cervical position on the bone ridge. Our technique increases the success rate of both the bone volume expansion and the dental implant placement, and improve the functional and aesthetic result of implant and prosthesis restoration. Four main types of bone expansion movement using corticotomies have been described: expansion with apical cortical hinge, cortical translation, bi-cortical osteotomy, and frame-shaped corticotomy. Our subject is the alveolar bone width augmentation with the frame- shaped corticotomy expansion technique, which allows to place an implant in a narrow and concave alveolar bone, with a straightened axis, without modifying its cervical position on the bone ridge arch. A series of 10cases with a 1 to 5year surgical follow-up is studied. Implants were all placed in the same stage and their supported prosthesis successfully made. Peculiarities and interest of this technique are discussed.

[Cardiovascular risk factors in Algeria. Analysis of the subgroup from the "Africa/Middle East Cardiovascular Epidemiological" Study]. / Facteurs de risque cardio-vasculaires en Algérie. Une analyse du sous-groupe de l'étude « Africa/Middle East Cardiovascular Epidemiological ¼.

OBJECTIVES: This cross-sectional epidemiological study aimed at determining the prevalence of cardiovascular risk factors (CVRF; including obesity, dyslipidaemia, hypertension, diabetes and smoking), among patients from the Algerian sub-population of the "Africa/Middle East Cardiovascular Epidemiological" study attending general practitioners at primary healthcare facilities, and stratified according to their environment (rural/urban), sex and age. PATIENTS AND METHODS: The study sites, located in 10 wilayas (administrative regions), were situated in urban and rural areas (rural populations defined as living at least 50km away from urban centres, or lacking access to suburban transport). RESULTS: Four hundred and ten subjects (262 female, 148 male) were enrolled; 287 subjects were from an urban environment and 123 from a rural environment. Mean age was 50.4 years. Ninety one point eight percent of patients had ≥1 CVRF; 48.2% had ≥3 CVRF. Prevalence for the different CVRF was: 61.7% for dyslipidaemia; 39.5% for hypertension; 25.0% for diabetes; 10.0% for smoking, 70.0% for abdominal obesity and 32.0% for a body mass index ≥30kg/m2. CONCLUSION: The high prevalence of all CVRF observed in the Algeria sub-group, especially among the rural population, should encourage us to develop a carefully planned strategy for primary prevention, opportunistic screening and early management, in both urban and rural settings, and with particular attention to young adults. These actions should involve all state bodies and those active in civil society, in order to guarantee full achievement of set goals. The ACE trial is registered under NCT01243138.

Neuroglial heterotopia of the scalp.

Heterotopic glial nodules of the scalp are non hereditary congenital malformations composed of mature brain tissue isolated from the cranial cavity. The majority of these lesions are found in the nasal region and occur rarely on the scalp. They are frequently diagnosed in newborn infants. However, they may rarely be found in adults. The pathogenesis of these lesions remains unknown. We describe the case of a temporal scalp nodule in a 50 year-old man. At the time of the excision, the mass was not associated with intracranial connection. Histological examination revealed neural tissue staining with S100-protein and the glial fibrillary acidic protein (GFAP).

A puzzling ovarian tumour: pregnancy luteoma with diffuse endometriosis.

BACKGROUND: Pregnancy luteoma is a distinctive non-neoplastic hormone dependent lesion arising in pregnancy and mimicking an ovarian tumour. Fewer than 200 cases have been described in the English-language literature. Its clinical and morphological features are characteristic and must be considered in order to prevent diagnostic misinterpretation. To the best of our knowledge the association of pregnancy luteoma with endometriosis has not been reported in literature to date. CASE REPORT: A 30-year-old pregnant woman with no particular past medical history, consulted her gynaecologist at 17 weeks gestation for routine check-up. The patient was asymptomatic and did not show any signs of virilization. Ultrasonography disclosed a left adnexal heterogeneous mass measuring 7 cm in diameter with intramural vegetations. The right ovary was unremarkable. The patient underwent salpingo-oophorectomy considering the imaging findings were suspicious for malignancy. Histologically, the lesion was constituted of large sheets of luteinized polygonal cells with abundant eosinophilic cytoplasm and small round nuclei devoid of atypia and mitotic figures. In addition, there were several ectopic endometrial glands surrounded by abundant decidualized or edematous stroma. Immunohistochemically, these glands were immunoreactive for cytokeratin 7. The final pathological diagnosis was pregnancy luteoma associated with diffuse endometriosis. CONCLUSIONS: Because of its relative rarity, pregnancy luteoma is likely to be clinically misinterpreted and overtreated, as in the present case.

Jejunal lymphangioma: an unusual cause of intussusception in an adult patient.

Adult intussusception is a relatively rare clinical entity. Almost 90% of cases of intussusception in adults are secondary to a pathologic condition that serves as a lead point. Lymphangioma of the small bowel is an unusual tumour that has been rarely reported to cause intussusception. In this paper, we present a rare case of adult intussusception due to jejunal lymphangioma. A 22-year-old female patient with a medical history significant for anaemia presented with intermittent colicky abdominal pain, diarrhoea and oedema of the inferior limbs for the past three months. Ultrasonography and CT scan revealed a typical target sign with dilated intestinal loops. At laparotomy, a jejuno-jejunal intussusception was found. Partial resection of the jejunum was performed. Macroscopic examination of the surgical specimen revealed a pedunculated polyp measuring 2 cm in diameter. Histological sections of the polyp revealed in the lamina propria and submucosal layer of the jejunum several markedly dilated thin-walled lymphatic spaces lined with single layers of flat endothelial cells. The final pathologic diagnosis was submucosal lymphangioma. This case report indicates that intussusception, although rare in adults, should be considered in the differential diagnosis of abdominal pain. Moreover, it should be taken into consideration that lymphangioma is one of the possible lesions that can cause intussusception.

Oxidative damage and histopathological changes in lung of rat chronically exposed to nicotine alone or associated to ethanol.

Smoking is the most important preventable risk factor of chronic obstructive pulmonary disease and lung cancer. This study was designed to investigate oxidative damage and histopathological changes in lung tissue of rats chronically exposed to nicotine alone or supplemented with ethanol. Twenty-four male Wistar rats divided into three groups were used for the study. The nicotine group received nicotine (2.5mg/kg/day); the nicotine-ethanol group was given simultaneously same dose of nicotine plus ethanol (0.2g/kg/day), while the control group was administered only normal saline (1 ml/kg/day). The treatment was administered by subcutaneous injection once daily for a period of 18 weeks. Chronic nicotine administration alone or combined to ethanol caused a significant increase in malondialdehyde (MDA) level, superoxide dismutase (SOD) activity and catalase (CAT) activity in lung tissue compared to control rats suggesting an oxidative damage. However, these increases were mostly prominent in nicotine group. The histopathological examination of lung tissue of rats in both treated groups revealed many alterations in the pulmonary structures such as emphysema change (disappearance of the alveolar septa, increased irregularity and size of air sacs) and marked lymphocytic infiltration in perivascular and interstitial areas. However, the changes characterized in the nicotine group (pulmonary congestion, hemorrhage into alveoli and interstitial areas, edema) were more drastic than those observed in the nicotine-ethanol group, and they can be attributed to a significant degree of capillary endothelial permeability and microvascular leak. Conversely, the ethanol supplementation caused an appearance of fatty change and fibrosis in pulmonary tissue essentially due to a metabolism of ethanol. Finally, the lung damage illustrated in nicotine group was more severe than that observed in the nicotine-ethanol group. We conclude that the combined administration of nicotine and ethanol may moderate the effect of nicotine administered independently by counteractive interactions between these two drugs.

Neuroendocrine tumours of the pancreas: a clinicopathological study of nine cases including six insulinomas.

BACKGROUND: Pancreatic neuroendocrine tumours (pNET) are relatively uncommon, accounting for 1-2% of all pancreatic neoplasms. They are characterised by varying clinical presentation, tumour biology and prognosis. AIM: To provide an updated overview on clinicopathological features, treatment and outcome of pNET. PATIENTS AND METHODS: In our retrospective study, we reviewed 9 cases of pNET that were diagnosed at the Pathology Department of Mongi Slim Hospital over an 11-year period (2003- 2013). Relevant clinical information and microscopic slides were available in all cases and were retrospectively reviewed. The latest WHO classification (2010) was adopted. RESULTS: Our study group included 3 men and 6 women (M/F ratio 0.5) with an age between 20 and 75 years (mean = 52 years). Pancreatic neuroendocrine tumours ranged in size from 0.5 to 10 cm (mean 4 cm). The sites of pNET were the head of the pancreas (n = 4), the body of the pancreas (n = 3) and the tail of the pancreas (n = 2). Enucleation of the tumour was performed in five cases, Three patients underwent distal pancreatectomy and splenectomy, whereas only one patient had central pancreatectomy. Histopathological examination of the surgical specimen coupled with immunohistochemical study established a diagnosis of pNET grade 1 (G1) in seven cases and grade 2 (G2) in two cases. CONCLUSION: Pancreatic neuroendocrine tumours are a heterogeneous group of neoplasms with distinct tumour genetics, biology and clinicopathological features. Accurate clinical and pathologic diagnosis is an important first step in developing an appropriate management plan.

Hydatid cyst presenting as a breast lump in a male patient.

The breast is a rare primary site of hydatid disease and accounts for only 0.27% of cases. Mammary hydatidosis generally occurs in females and has never been described in male patients. In this paper, the authors report a new case of isolated hydatid cyst of the breast in a 35-year-old previously healthy man, who presented with a left breast painless lump of one year duration. Physical examination showed a non-tender and immobile mass in the upper lateral quadrant of the left breast, with normal overlying skin and nipple. There was no palpable lymph node in the left axilla and the contralateral breast was normal. Ultrasonography showed a 2.7 x 1.5 cm cystic lesion in the left breast. The patient underwent total excision of the mass, and histopathological examination confirmed the diagnosis of hydatid cyst. The authors conclude that although hydatid cyst of the breast is rare, it should be considered in the differential diagnosis of breast lumps especially in endemic areas.

Sclerosing stromal tumour of the ovary: two case reports.

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. Herein, we report two cases of sclerosing stromal tumour of the ovary. The two patients were 16 and 45 years old and both presented with pelvic pain. Ultrasonography demonstrated a heterogeneous solid mass of the left and right ovary, respectively, with some cystic foci in the second tumour. Laboratory tests including tumour markers and serum hormonal assays were normal in both cases. The two patients underwent left and right salpingo-oophrectomy, respectively. Microscopically, the tumours showed a pseudolobular pattern with cellular areas separated by oedematous and collagenous areas. The cellular areas were richly vascularized, with a hemangiopericytic pattern, and were composed of an admixture of theca-like and spindle-shaped cells. Immunohistochemical studies showed that the tumour cells were positive for smooth muscle actin, inhibin and vimentin, but negative for cytokeratin. The final pathological diagnosis was sclerosing stromal tumour. Postoperative course was uneventful for both patients.

Pancreatic heterotopia of the small intestine: two case reports.

The presence of heterotopic pancreas is unusual with an estimated incidence of 0.2% of upper abdominal operations. Heterotopic pancreas occurs predominantly in the stomach, duodenum and proximal jejunum. Isolated pancreatic heterotopia of the ileum is very rare and is usually found in a Meckel's diverticulum. In most cases, these heterotopias are asymptomatic and are only incidentally detected upon pathological examination or autopsy. In this paper, the authors report two cases of pancreatic heterotopia involving, respectively, the duodenum and ileum that were fortuitously discovered on a surgical specimen and during laparotomy for unrelated causes.

Coexistence of xanthogranulomatous cholecystitis and gallbladder adenocarcinoma: a fortuitous association?

Xanthogranulomatous cholecystitis is a relatively uncommon variant of chronic cholecystitis, characterized by marked thickening of the gallbladder wall and dense local adhesions. Not only does xanthogranulomatous cholecystitis mimic malignancy, it can also be infrequently associated with gallbladder carcinoma in 0.2% to 35.4% of cases. Herein, the authors report a new case of xanthogranulomatous cholecystitis concomitant with gallbladder adenocarcinoma in a 65-year-old female patient. Because of its overlapping clinical, radiological and macroscopic findings with gallbladder cancer, definitive diagnosis of xanthogranulomatous cholecystitis relies on extensive sampling and thorough microscopic examination of the surgical specimen to exclude the possibility of coexisting tumour. It is still a matter of debate whether xanthogranulomatous cholecystitis is truly a precursor of gallbladder carcinoma or if it is just an incidental finding. This aspect needs to be explored in the future with further studies.

Coexistence of lobular granulomatous mastitis and ductal carcinoma: a fortuitous association?

A 77-year-old female patient with a medical history significant for hypertension and epilepsy presented with right breast pain of 6-months duration. Examination revealed a hard sub-areola tender mass with irregular borders associated with mild right nipple retraction. Mammography showed a 2.2 x 2.4 cm stellate mass of the right breast. Ultrasound-guided core biopsies of the tumour were performed. Pathological examination revealed a grade II infiltrating ductal carcinoma. The patient underwent right radical mastectomy with homolateral axillary lymphadenectomy. Histological examination of the surgical specimen revealed grade II infiltrating ductal carcinoma concomitant with granulomatous lobular mastitis. To the best of our knowledge, the coexistence of granulomatous lobular mastitis and ductal carcinoma has been described only twice in the English language literature. The theory that chronic inflammation leads to cancer is well documented. Whether our patient had developed cancer from granulomatous lobular mastitis or otherwise is a matter of debate until more cases are encountered and more research is done in the area of breast cancer pathogenesis with regards to it arising from granulomatous lobular mastitis.

Adrenal epithelial cyst: a case report.

Epithelial-lined or true cysts of the adrenal gland are exceedingly rare accounting for only 9% of all adrenal cysts. A 55-year-old woman with a medical history for cholecystectomy and liver hydatidosis presented with an 8-month history of abdominal pain in the upper left quadrant. Physical examination was unremarkable and laboratory tests were within normal range. Computed tomography displayed a homogeneous and finely calcified cystic mass of the left adrenal gland measuring 12 x 10 cm. A hydatid cyst of the adrenal gland was suspected preoperatively and the patient underwent uneventful excision of the cyst. Histological examination of the surgical specimen revealed that the cyst wall was lined by cuboidal to flattened cells with bland cytologic features. Immuohistochemically, the cyst lining expressed intensely cytokeratin but was negative for CD 34 and calretinin. The final pathological diagnosis was epithelial adrenal cyst.

Idiopathic granulomatous mastitis mimicking breast cancer: report of two cases.

Idiopathic granulomatous mastitis is a rare inflammatory breast disease of unknown aetiology that is frequently mistaken for breast carcinoma both clinically and mammographically. In this paper, the authors report two cases of idiopathic granulomatous mastitis that occurred in two parous women aged 38 and 45 years. Clinically, both patients presented with a tender palpable lump in the left breast. Mammography showed an poorly-defined mass in both patients with microcalcification in the first case and skin retraction in the second case. Breast lumpectomy was performed in both patients. Histological examination of the surgical specimen revealed non-caseating granulomas confined to breast lobules. Special staining for fungi and tuberculosis were all negative. Correct diagnosis ofidiopathic granulomatous mastitis requires the exclusion of malignancy, other granulomatous disease and infectious aetiologies. Histopathologic examination remains the gold standard for diagnosis. This disease is rare, and therefore the optimum treatment protocol is still being established.

Localized ileal giant pseudopolyposis in Crohn's disease: a case report.

Localized giant pseudopolyposis is a rare complication in inflammatory bowel disease defined as a pseudopolyp (isolated or clustered) larger than 1.5 cm in size. Giant pseudopolyps are more commonly found in ulcerative colitis compared to Crohn's disease and mainly involve the left colon. A 26-year-old male patient with a two-year history of Crohn's disease was admitted with increasing abdominal pain, vomiting, anorexia, weight loss and fever. On physical examination, the abdomen was diffusely tender. Computed tomography showed diffuse irregular thickening of the ileal wall and stenosis of the terminal ileum. The patient underwent ileo-cecal resection with re-anastomosis. The ileal portion of the resected specimen harboured multiple finger-like pedunculated polyps, with the smallest measuring 0.5 cm and the largest measuring 1.8 cm. Histologically, the polyps were consistent with granulation tissue. No evidence of dysplasia or malignancy was found. The post-operative course was uneventful considering one month follow-up. This report illustrates an unusual case of giant pseudopolyposis involving the ileum in a patient with Crohn's disease. The natural history of these lesions, as well as their optimal management, remain uncertain.

Pancreatic heterotopia in the gallbladder neck associated with chronic cholecystitis.

The gallbladder is an unusual location of pancreatic heterotopia defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of the gland. A 55-year-old previously healthy male patient presented with repeated attacks of right hypochondriac pain and vomiting. On physical examination, the right upper abdomen was tender to palpation with a positive Murphy's sign. Abdominal ultrasonographic examination showed multiple gallstones within a thin-walled gallbladder. Laparoscopic cholecystectomy was performed with uneventful recovery. Macroscopic examination of the surgical specimen revealed a yellowish intramural nodule measuring 7 mm close to the neck of the gallbladder. Histological examination revealed chronic cholecystitis and subserosal foci of heterotopic pancreas made up of exocrine acinar and ductal elements without islet cells corresponding to incomplete heterotopia. Heterotopic pancreas is usually detected as an incidental microscopic finding in a gallbladder specimen removed by cholecystectomy. Pre-operative diagnosis is difficult primarily due to its non-specific clinical features.

Case report: Primary pure squamous cell carcinoma of the gallbladder.

Squamous cell carcinoma of the gallbladder is rare, accounting for only 0.5-12.7% of all malignant gallbladder tumors. Tumor progression is rapid but silent and therefore usually discovered at an advanced stage, hence its poor prognosis. We report the observation of a 69-year-old woman with known cholelithiasis, admitted for biliary colic. CT scan highlighted a thick-walled gallbladder harboring a tumor invading segments IV and V of the liver. The patient underwent cholecystectomy associated with bisegmental hepatic resection. Pathology showed a well-differentiated, keratinizing squamous cell carcinoma, infiltrating the entire gallbladder wall and the adjacent hepatic parenchyma.

Adenomatous transformation in a giant solitary Peutz-Jeghers-type hamartomatous polyp.

Solitary Peutz-Jeghers-type polyp is a rare hamartomatous polyp without associated mucocutaneous pigmentation or a family history of Peutz-Jeghers Syndrome. It is usually encountered in the small intestine, but rarely involves the rectum. A 27-year-old previously healthy female patient presented with a two-month history of rectal bleeding. The patient had neither mucocutaneous pigmentation nor a family history of gastro-intestinal polyposis. Endoscopic examination revealed a solitary lobular polypoid lesion in the lower rectum. The polyp was sessile and measured 15 cm in diameter. As histological examination of the biopsy specimen was suggestive of adenoma, endoscopic polypectomy was performed. Histologically, this polyp had an arborizing muscular network originating from the muscularis mucosa, and was covered by well organized mucosa with several foci of dysplastic glands. The final pathological diagnosis was solitary Peutz-Jeghers type hamartomatous polyp with adenomatous transformation.

Implication of the Galectin-3 in colorectal cancer development (about 325 Tunisian patients).

Galectin-3 is a specific soluble lectin of the beta-galactoside family. It plays an important role in cell adherence, proliferation, and differentiation. It has also been shown that galectin-3 expression correlates with tumor progression in several types of cancers. We investigated the involvement of galectin-3 in colorectal cancer development. We performed a comparative immunohistochemical analysis of galectin-3 expression in term of intensity and distribution in normal mucosa, in primary tumor and in metastasis from 200 patients with colorectal cancer selected among 325 cases. We also compared the galectin-3 staining according to the histological subtype (mucinous vs non mucinous), tumoral differentiation and stage of tumor. We showed a strong and diffuse positive staining of galectin-3 in both adjacent and distanced normal mucosa, in well differentiated adenocarcinoma and in metastasis. However, we note a progressive decrease of galectin-3 staining according to the decreasing degree of tumoral differentiation. We also observed a loss of this protein in adenocarcinoma with mucinous component < 50%, where the positive staining was limited only to the well differentiated areas of tumor. These data suggest that galectin-3 play an important role in colorectal cancer progression concerning the non mucinous carcinoma and can be used as a prognostic factor to predict poor outcome of patients. In mucinous subtype, galectin-3 might be implicated in one or many step of its genesis perhaps through the control of cellular adhesion and interaction with mucin produced. Adenocarcinoma with mucinous component <50% would be integrate to mucinous carcinoma, not to non mucinous ones. These investigations could open perspectives for therapeutic means targeted to improve the prognosis of this neoplasm.

Gynandroblastoma. Report of an unusual ovarian tumour and literature review.

Gynandroblastoma is a rare variant of ovarian sex cord stromal tumours that demonstrates morphological evidence of both male and female differentiation. We report a new case of gynandroblastoma in a 22-year-old nulliparous female with a history of menstrual disturbance. Physical examination disclosed a painless pelvic mass measuring 20 cm across with normal secondary sex characteristics, and no signs of virilisation. Histological examination of the surgically resected primary tumour revealed a predominant adult granulosa cell component admixed with a minor Sertoli cell component that did not exceed 20% of the tumour. Immunohistochemical analysis showed positive immunostaining of Sertoli cell areas with inhibin. The final diagnosis was gynandroblastoma. The post-operative course was uneventful and there was no evidence of recurrence during the 9-month follow-up period.