Angiomyofibroblastoma of the spermatic cord: a case report.

Angiomyofibroblastoma (AMF) is a rare benign mesenchymal tumor with tendency to arise in the lower genital tract of middleaged women, predominately in the vulva. A few cases of AMF in males have been reported involving the scrotum, perineum or spermatic cord. We report a new case of AMF arising in the right inguinal region of a 27-year-old man. The tumor was well-circumscribed, myxoid and measured 30 mm in maximum dimension. On microscopic examination, the tumor was composed of spindle cells without atypia and with less than one mitosis figure per 10 high-power fields. Multinucleated cells and mast cells were observed. The stroma was myxoid and edematous with abundant capillary-sized blood vessels. Immunohistochemical staining showed a strong immunoreactivity for desmin and smooth muscle actin. The tumor cells were negative for estrogen receptors and focally positive for progesterone receptors with a low proliferative index of Ki67 (< 5%). This unusual neoplasm should be distinguished from aggressive angiomyxoma and other myxoid malignant tumors.

Prognostic value of immunohistochemical expression profile of epidermal growth factor receptor in urothelial bladder cancer.

We studied epidermal growth factor receptor (EGFR) expression profile in urothelial bladder carcinoma (UBC) which is a complex and heterogeneous disease with a large spectrum of histological aspects and deadly potential. Using immunohistochemistry (IHC), all GI tumors and pTa cases showed a low expression profile of EGFR. However, we note that when the stage of disease is advanced, tumors over-express EGFR. Indeed, 5% and 25% of GII and GIII tumors over-expressed EGFR, respectively. Further, 0% of pTa, 9,5% of pT1, 15% of pT2, 50% of pT3, and 90% of pT4 tumors were shown to be high EGFR expression (HEE). Moreover, we found a statistically significant correlation between the EGFR over-expression and grade and stage (P < 0.05). Thus, EGFR over-expression could be a potential prognostic marker to predict poor outcome in Tunisian patients with UBC.

Unilateral orbital mass as an unusual presentation of IgG4-related disease.

IgG4-related diseases are a recently recognized systemic syndrome characterized by mass-forming lesions, in mainly exocrine tissue, that consist of lymphoplasmacytic infiltrates and sclerosis, which may mimic malignant neoplasm due to clinical and imaging features. We report an unusual case of a 62-year-old woman who presented with a left orbital mass, which histologically revealed to be an IgG4-sclerosing disease.

Papillary haemangioma: a case report of multiple facial location.

Papillary haemangiomas were recently defined as morphologically distinct and benign cutaneous haemangiomas showing a predominantly intravascular capillary proliferation within dilated thin-walled dermal blood vessels. We describe the case of a 45-year-old woman who presented with multiple eruptive red-bluish raised papules and nodules distributed over the skin of the chin that were related to a papillary haemangioma.

[Cervical node fine needle aspiration: factors influencing the failure rate]. / Cytoponction ganglionnaire cervicale : facteurs influençant le taux d'échec.

INTRODUCTION: We had for aim to study the factors influencing the rate of non satisfactory (NS) cervical node fine needle aspirations (CNFNA). MATERIALS AND METHODS: We prospectively included 272 CNFNA, performed over 2 years (2010-2012). NS results were studied according to the following criteria: age, size and location of the node, number of punctures performed, and the operating physician's experience. RESULTS: Fifty-six (20.6%) of the 272 CNFNA were NS because they were acellular or paucicellular. The rate of NS CNFNA was not correlated with the patient's age: 63.6% for small lymph nodes (≤1 cm: P=0.01). Submandibular and jugulodigastric locations were observed in 28% of NS CNFNA and in 5% of satisfactory ones (P=0.001). The rate of NS CNFNA was 67% if 1 or 2 punctures were performed; it decreased to 18% for 3 or more punctures (P=0.01). This rate was 77% for the first study semester, and 8% for the fourth semester (P=0.001). CNFNA has been repeated for 19 patients. The second CNFNA was contributive for 14 patients. Repeating the CNFNA increased its efficiency by 73.7% (14/19). DISCUSSION: The rate of NS CNFNA depends on the size and location of the lymph node, and the operating physician's experience. Repeating the CNFNA significantly improves its efficiency.

[Osteoclast-type giant cell tumor of the parotid gland]. / Tumeur à cellules géantes de type ostéoclastique de la parotide.

INTRODUCTION: Osteoclast-type giant cell tumors of the salivary gland are extremely rare; only 23 cases have been reported. Two presentations were observed: isolated tumor or tumor associated with a carcinomatous contingent. CASE REPORT: A 51-year-old female patient consulted for a painless left retro-angulo-mandibular swelling having appeared 2 years before. This was a 2 cm parotid mass without facial nerve palsy or cervical lymphadenopathy. The patient underwent a superficial parotidectomy to remove the nodule. The direct microscopic examination revealed an osteoclastic giant cell tumor without any carcinomatous contingent. At immunohistochemistry, mononuclear cells were diffusely and intensely stained by anti-pancytokeratin, while multinucleated cells were totally negative and CD68 positive. The patient was not given any complementary treatment. She was followed-up 23 months later and did not present any signs of recurrence or metastasis. DISCUSSION: The histogenesis and nosology of osteoclastic giant cell are currently unknown. Although this entity was not integrated into the latest WHO classification, most authors consider it as a variant of carcinoma. Published data on the epithelial or histiocytic nature of multinucleated cells is not consensual. Our case presentation supports the hypothesis of a histiocytic differentiation of giant cells and epithelial mononuclear cells.

Adenocarcinoma arising in a tailgut cyst: a case report.

Tailgut cyst (TGC), also called retrorectal hamartoma, is a rare congenital lesion arising from persistent remnants of the postanal gut. Malignant transformation of TGC is exceedingly uncommon. We report herein the clinicopathologic features and the follow-up of a new case of a TGC with adenocarcinomatous transformation occurring in a 61 year-old woman.

Hydatid cyst of the breast: a case report.

Echinococcal involvement of the breast is extremely rare, even in the endemic countries. We report the case of a 31-year-old woman who presented with a 5 cm mammary mass. Mammography and sonography showed a well-circumscribed cystic lesion. Diagnosis of hydatid cyst was confirmed by pathological examination.

[Detection of Epstein-Barr virus in breast cancers with lymphoid stroma]. / Détection du virus d'Epstein-Barr dans les cancers du sein à stroma lymphoïde.

OBJECTIVE: the purpose of our work is to detect Epstein-Barr virus (EBV) in 2 types of breast cancer: medullary carcinoma and high grade invasive ductal carcinoma with lymphoid stroma. PATIENTS AND METHODS: we proceeded to a retrospective study of 18 medullary carcinoma and 18 high grade invasive ductal carcinoma with lymphoid stroma. The detection of the virus was carried out by immunohistochemistry with anti-LMP2 antibody and by hybridization in situ by oligonucleotides EBER1 and EBER1. LMP1 as well as hybridization in situ were positive in 5 tumors (3 medullary carcinoma and 2 high grade invasive ductal carcinoma with lymphoid stroma). RESULTS: positivity was observed in tumor cells and neither in epithelial non tumoral ones nor in lymphoid cells. DISCUSSION AND CONCLUSIONS: during numerous years, correlations between the replication of EBV and the appearance of a malignant phenotype were limited to nasopharyngeal carcinoma and to lymphoid cells. A controversy regarding the association of EBV with breast cancers has recently been reported in the literature. This cancer being very frequent, the involvement of EBV even in a small proportion of breast cancers could have important implications. Our results suggest a possible implication of EBV in these tumours but other studies are necessary.

Adenome parathyroidien intrathymique: a propos d'un cas

Introduction : Les adenomes parathyroidiens posent le probleme de leur diagnostic topographique. A partir d'un cas clinique d'adenome parathyroidien intrathymique; les auteurs rappellent l'interet d'un bilan localisateur preoperatoire. Observation : Il s'agit d'un homme age de 19 ans presentant une hyperparathyroidie primitive. La scintigraphie a la Sestamibi a montre une hyperfixation inhabituelle du radiotraceur au niveau du creux sus sternal; permettant d'evoquer le diagnostic d'un adenome parathyroidien intrathymique. Il a ete realise une adenectomie en utilisant une voie d'abord cervicale et l'evolution post-operatoire etait favorable. Conclusion : La scintigraphie Sestamibi constitue l'examen de choix pour etablir le diagnostic topographique des adenomes parathyroidiens. Cet examen permet de limiter la voie d'abord chirurgicale et d'eviter les cervicotomies blanches

[Mesenchymal tumors of the digestive tract, immunohistochemistry contribution]. / Les tumeurs mésenchymateuses du tube digestif, apport de l'immunohistochimie.

UNLABELLED: Mesenchymal tumors of the digestive tract are rare and display variable morphological appearances. Thanks to immunohistochemistry and molecular biology, these tumors are now better classified and dominated by stromal tumors. AIMS: the aim of this article is to study morphological characteristics of mesenchymal tumors of the digestive tract and to insist on immunohistochemistry contribution to diagnosis, especially the c-Kit. MATERIALS AND METHODS: this is a retrospective study of 40 mesenchymal tumors of the digestive tract diagnosed before the event of c-Kit, from 1985 to 1999 in the pathology laboratory of F. Hached hospital in Sousse. Immunohistochemical studies were performed on these tumors with the following antibodies: c-Kit, CD34, smooth muscle actin and S-100 protein. RESULTS: after immunostaining, the tumors were reclassified as the following: 33 stromal tumors, 4 leiomyosarcomas, 1 leiomyoma, 1 schwannoma and 1 desmoid tumor. CONCLUSION: mesenchymal tumors of the digestive tract are dominated by stromal tumors. The latter are defined usually by a spindle cell proliferation, often expressing the c-Kit protein which must be used in all mesenchymal tumors of the digestive tract.

[Low-grade central chondrosarcoma: difficult diagnosis in an adolescent girl]. / Chondrosarcome central de bas grade: un diagnostic difficile: à propos d'un cas.

Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.

[Adenocarcinoma and gastro-intestinal stromal tumor: fortuitous association or a single carcinogenic agent? A report of 2 cases]. / Adénocarcinome et tumeur stromale digestifs: association fortuite ou mécanisme oncogène commun? A propos de deux observations.

The synchronous development of epithelial and stromal tumors of the digestive tract was rarely reported in the literature. Two such cases are described in this article. One is of a 44-year-old man presenting a high grade gastric stromal tumor associated with an adenocarcinoma of the large bowel. The other is of a 68-year-old man presenting an adenocarcinoma of the head of the pancreas associated with a low grade gastric stromal tumor. The hypothesis that the association is due to a simple coincidence particularly in areas with high rates of digestive cancer is proposed. A possibility of a genetic mutation or a single carcinogenic agent interacting with two tissues in the digestive tract and inducing the development of tumors of different histotype cannot be discarded.

Lipomatous hemangiopericytoma (adipocytic variant of solitary fibrous tumor) of the orbit. A case report with review of the literature.

Hemangiopericytoma (HPC) of the orbit is a rare tumor presenting with slowly progressive proptosis, ocular motility impairment and visual loss. In 1995, a newly variant of HPC termed lipomatous hemangiopericytoma (LHPC), was described. Only two cases arising in the orbit have been previously reported. The authors describe another case of orbital LHPC and discuss the clinicopathologic features, including the immunohistochemical staining profile and ultrastructural appearance of this distinctive tumor, and briefly discuss the relationship between HPC and solitary fibrous tumor of soft tissue, a neoplasm with many clinical and pathologic similarities.

[Subcutaneous dirofilariasis due to Dirofilaria repens in Tunisia: a case involving the scrotum]. / Dirofilariose sous-cutanée à Dirofilaria repens en Tunisie: une observation à localisation scrotale.

Dirofilariasis is a rare anthroponotic disease encountered only in the old world with most cases having been reported from Italy. The dog is the reservoir of this parasite. Man is accidentally infected by mosquitoes. We report the case involving a 27-year-old man living in a rural region of northern Tunisia who presented with a subcutaneous abscess-like scrotal nodule. Microscopic examination of the surgical specimen unexpectedly revealed parasitic involvement. Morphologic examination led to diagnosis of subcutaneous dirofilariasis due to Dirofilaria repens. This case of subcutaneous dirofilariasis brings the total number of cases reported in Tunisia to 6 and is a reminder that this parasitic disease is present in our country and that its incidence is probably underestimated. The scrotum is a rare location that poses the problem of differential diagnosis with malignant tumor or can simulate a surgical emergency. Excision allows diagnosis and treatment.

[Infantile fibrosarcoma: a clinicopathological and molecular study of five cases]. / Fibrosarcome infantile: étude anatomo-clinique et moléculaire de cinq cas.

We report 5 cases of infantile fibrosarcoma (4 boys and 1 girl) whose average age was 5, 7 months (range 0 days to 14 months). The tumor was congenital in 4 cases. All tumors presented in the extremities (forearm, hand, thigh: 1 case, lower leg: 2 cases). Treatment was based on surgery (3 cases: amputation, 2 cases: local excision) with a favorable course in all cases, even those with marginal excision (follow-up ranging from 5 to 21 years). The lesions were characterized by dense monotonous cells growing in a fascicular pattern, with small necrotic areas and scattered lymphocytes. The mitotic index was high (average 8/10 high-power fields). ETV6-NK3 chimeric RNA was detected by reverse transcriptase polymerase chain reaction in two cases out four cases from paraffin-embedded tissue blocks. The infantile fibrosarcoma is a good prognosis tumor characterized by particular histological features and ETV6-NK3 gene fusion.