[The myofibroblastic inflammatory tumours: A fortuitous association or an unknown postpartum complication]. / Les tumeurs myofibroblastiques inflammatoires : association fortuite ou complication peu connue du post-partum ?

The inflammatory myofibroblastic tumour has clinical, biological or histological features sometimes misleading with a septic condition. Presenting symptoms are variable and arising circumstances remain obscure. We report three cases occurring in a postpartum context. The first patient, a 28-year-old female, had left psoitis with a sepsis the first day postpartum in relation with an inflammatory myofibroblastic tumour of the meso-ovary. The second patient, a 40-year-old woman, had a hepatic inflammatory myofibroblastic tumour revealed by a ruptured sub-capsular haematoma of the liver in the forth day postpartum. The third patient, a 32-year-old woman, had a pulmonary inflammatory myofibroblastic tumour, diagnosed 5 months after a delivery and which recurred 10 years after surgical treatment. These cases illustrate the difficulty to diagnose inflammatory myofibroblastic tumour, particularly in postpartum.

[Parotid mucormycosis: A new case and review of the literature]. / Mucormycose parotidienne : une nouvelle observation et revue de la littérature.

INTRODUCTION: Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman. REPORT: A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution. CONCLUSION: The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.

[Rhinocerebral mucormycosis in four diabetics]. / la mucormycose rhinocérébrale chez le diabétique. A propos de quatre observations.

UNLABELLED: Mucormycosis is caused by a zygomycetes fungus in a vascular location. This fungus is a saprophytic organism which can become pathogenic in specific conditions, particularly in patients with diabetes mellitus. A rhinocerebral localization is common, leading to often fatal devastating sinusitis. Positive diagnosis requires histological proof with characteristic hyphal tissue invasion. Frozen section is essential for diagnosis and management of rhinocerebral mucormycosis. MATERIAL AND METHODS: We report four cases of rhinocerebral mucormycosis in diabetic patients, two men and two women, mean age 51 years. RESULTS: Histological examination showed characteristic hyphae in a vascular localization. Treatment was systemic antifungal therapy with amphotericin B and debridement of necrotic tissue. Three patients recovered completely. One died. CONCLUSION: Rhinocerebral mucormycosis is a rare fungal infection with very poor prognosis. The aim of this study was to report the clinical and pathological features of rhinocerebral mucormycosis and to evaluate the contribution of frozen section for diagnosis and management.

[Cutaneous epithelioid hemangioendothelioma]. / Hémangioendothéliome épithélioïde cutané.

INTRODUCTION: Epithelioid hemangioendothelioma is a tumor of soft tissues arising from the vascular endothelium. It is considered as a low-grade malignant tumor. Cutaneous involvement is rare and often associated with multi-systemic localizations. CASE REPORT: We report the case of a 34 year-old woman with a 6-month history of a 1.5 cm erythematous-violaceous, soft, painful cutaneous nodule involving the right forearm. An abdominal sonography had been performed 1 month before the onset of the nodule, because of epigastric pain and was normal. Histological and immunohistological examinations led to diagnosis of an epithelioid hemangioendothelioma. Assessment of the extension with radiology, sonography, tomodensitometry and magnetic resonance imaging, revealed nodules of the liver. Treatment consisted in the wide and complete excision of the tumor. There was no evidence of local recurrence after one year follow-up, and the hepatic lesions were stable. DISCUSSION: Epithelioid hemangioendotheliomas belong to the epithelioid vascular tumor spectrum. They have in common the morphologic epithelioid aspect of endothelial tumor cells. Cutaneous localization is rare, and to the best of our knowledge, only 20 cases of epithelioid hemangioendothelioma with skin involvement have been reported in the literature. Epithelioid hemangioendothelioma can be isolated or associated with internal visceral involvement. The detection of skin lesions should lead to a complete assessment of the extension of the disease to detect any internal localization. Because of low-grade malignancy of the tumor, and the integrity of the liver observed one month before the onset of the disease in our patient, epithelioid hemangioendothelioma appears to be a multicentric disease rather than metastatic hepatic localizations of a primitive skin cancer.

[Epibulbar osseous choristoma: two case reports]. / Ostéome épibulbaire: à propos de 2 cas.

INTRODUCTION: Epibulbar osseous choristoma is a congenital tumor consisting of normal tissue arising in an abnormal location. CARE REPORTS: We report two cases of epibulbar osseous choristoma discovered in 7- and 3-year-old girls. FIRST CASE: A calcified tumor was located regarding the temporal bulbar conjunctiva of the left eye. The rest of the ophthalmological examination was normal. Second case: During strabismus surgery, we unexpectedly discovered a white calcified mass located on the superior temporal part of the right eye. In both cases, a total excision was performed. Histopathological examination of the excised choristoma confirmed the diagnosis. DISCUSSION: Epibulbar osseous choristoma is a small unique nodule usually located on the superior temporal quadrant of the eye. Rarely reported in the literature, most cases are not recognized clinically and the diagnosis is essentially histopathological. CONCLUSION: Epibulbar osseous choristoma is a rare benign childhood tumor with an essentially histopathological diagnosis.

[Cutaneous tuberculosis: anatomoclinical features and clinical course (26 cases)]. / Tuberculose cutanée: aspects anatomocliniques et évolutifs (26 cas).

INTRODUCTION: Despite prevention programs, tuberculosis is still progressing endemically in developing countries. The prevalence of cutaneous tuberculosis is estimated as 2.1 p. 100 and represents a rare localization among the extra-pulmonary forms. In order to study the epidemiology, the most frequent anatomoclinical forms and the progressive features of cutaneous tuberculosis, we conducted a study in the area of Tunis over a 20-year period. PATIENTS AND METHODS: All cases of cutaneous tuberculosis observed between 1981 and 2000 in the dermatology department of the Habib Thameur hospital were included in a retrospective study. Diagnosis of cutaneous tuberculosis was challenging and required the correlation of clinical, biological and progressive features. RESULTS: Twenty-six patients were observed in the study. There were 12 men and 14 women with a mean age of 30.4 years (range: 6-74) and 20 p. 100 of infantile cases. Of the various patterns of cutaneous tuberculosis seen, 11 (42 p. 100) had lupus tuberculosis, 10 (38 p. 100) had scrofuloderma, 4 (15 p. 100) had tuberculosis verrucosa cutis and 1 child had a perianal tubercular ulcer. The Mantoux test was positive in 20/24 patients. Histological tuberculoid granuloma was seen in 25 cases (96 p. 100) associated with caseating necrosis in 10 cases (38 p. 100). All patients were treated successfully with triple or quadruple anti-tubercular drugs for 6 to 10 months. One patient exhibited a squamous cell carcinoma on a lupus tuberculosis scar four years later. DISCUSSION: The progression of cutaneous tuberculosis remains stable, ranging from 1.4 cases/year between 1981 and 1990 to 1.2 cases/year between 1991 and 2000. In our study, females were slightly more affected than men with a M/F sex ration of 0.86. Before 1984, scrofuloderma was the most frequent form among the cutaneous tuberculoses. Now the frequency of lupus tuberculosis has reached that of scrofuloderma, demonstrating the increase in the incidence of clinical pattern of cutaneous tuberculosis with strong immunity probably related to the improvement in health conditions and generalization of vaccination programs.

[Struma ovarii. Three malignant cases and one benign case]. / Goitres ovariens. A propos de trois cas malins et un cas bénin.

Four cases of struma ovarii were seen among 308 ovarian tumors removed surgically at the Salah Azaiz Institute, Tunis, Tunisia, between 1980 and 1989. This yields an occurrence rate of 1.3%, which is comparable to previously publishes rates (0.3% to 2%). One of the four tumors was malignant. Malignant transformation of struma ovarii is very rare (5% to 10%). The histologic diagnosis of malignancy is difficult, particularly in well-differentiated follicular forms. The prognosis is relatively favorable even in patients with metastases. Based on their personal experience and on a review of the literature, the authors discuss the diagnosis, management, and outcome of struma ovarii, in particular with malignant transformation.